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DISSERTATIOxN 



PRACTICE OF MEDICINE. 



CONTAINING AN ACCOUNT OP THE CAUSES, 
SYMPTOMS, AND TREATMENT, 

of diseases: 



ADAPTED TO THE USE 



PHYSICIANS AND FAMILIES. 



BY 



TOML.INSOJ* FORT, M. D 



MILLEDGEVILLE, GA. 

PRINTED AT THE FEDERAL UNION OFFICE . 

1849. 






Entered according to Act of Congress, in the year 1848, by 

TOMLINSON FORT, M. D. 

the Clerk's Office of the District Court of the United States, for the District 

of Georgia. 



0/3 V*. 



TO THE 



PHISICIANS OF THE STATE OF GEORGIA. 

Gentlemen : 

I dedicate to you, this Dissertation on the Practice 
of Medicine, as a grateful acknowledgement of the kind- 
ness, respect, and confidence, which I have experienced at 
the hands of every one of you, with whom I have had the 
honor of becoming acquainted ; and to show that I have great 
reliance in your ready acquiescence in this attempt, to give to 
the science of Medicine, a wider range in the mental opera- 
tions of the age. 

With great respect, your ob't serv't, 

TOMLINSON FORT. 
Milledgeville, January 23d, 1849. 



ADVERTISEMENT. 



I have anticipated great satisfaction in writing an introduc- 
tion of my work to the reader ; but a violent illness has dis- 
qualified me for the task. My promise to the public can no 
longer be delayed, and I must substitute a short Advertise- 
ment for the essay I had intended to write. 

I confess that it was a great object with me, to present my- 
self to the best advantage before the Medical Profession. 
It was my purpose to shew them, that the time had arrived, 
when a diffusion of medical knowledge among men, was ne- 
cessary to the continuance of their confidence in the science, 
or its professors ; that the decline of that confidence which is 
manifest in this day of increasing civilization, has arisen from 
the vain attempt to make medicine an exclusive property in 
the hands of those who pursue it as a profession ; that 
the belief of every preposterous theory so readily entertain- 
ed, and the sport with human life now carried on so widely 
under courses of treatment as opposite as they are destruc- 
tive, are cherished and kept up by the same cause; that instead 
of putting down the quack, this exclusive system, is the ram- 
part behind which he stands in safety, and makes more b} r 
the random fling of ignorance and rapacity, than the most 
gifted of his adversaries by years of study and labor ; and, 
finally, that it would be greatly to the credit of medical men, 
and profitable to the whole profession, to throw open the doors 
of their science, and by all practicable means induce man- 
kind to consider it their duty to obtain some knowledge of it 
for themselves. No man can be certain that it will always 
be in his power to obtain medical advice, for every one is sub- 
ject to a thousand casualties which will compel him to rely on 
his own skill ; and this necessity against which there is no 
defence, will operate with greater power over the thousands 
of our best citizens, who are scattered abroad in the country. 
And where is the language in which to address the millions 
of all classes, who are daily swallowing drugs of which they 
have no knowledge ; and who would be filled with dismay 
at sight of those who claim to be their inventors . ? Shall 
we repeat the statement, that no remedy of any value has 
ever been added to medicine by these pretended inventors ; 



VI ADVERTISEMENT. 

or shall we say of their victims, they are joined to their idols, 
" let them alone ?" But I must' desist. 

I have made very few acknowledgements to authors, for 
the aid I have derived from their labors. This work is in 
its nature ephemeral: its author does not claim for it a place 
among the standard works of the day. Should its reception 
warrant it, he hopes to live to remedy some of its defects, 
and especially, to do justice to the labors of others. 

A few words to the common reader, and I have done. I 
have found it impracticable, to avoid the use of technical 
words, which may at first be a source of some embarrass- 
ment. You will find, however, as you progress, that they are 
often so used as to need no explanation, and that those which 
require explanation, are placed together, alphabetically, near 
the close of the book, and there defined. By referring to 
those definitions, the meaning of the terms used will be easily 
ascertained. 

Some of the most important diseases are treated of at con- 
siderable length. In these cases, I thought it useful to reca- 
pitulate the remedies used, at the close of the essay. By re- 
ferring to this, the reader will never be at a loss for his reme- 
dies. In shorter essays, I have thought these recapitulations 
unnecessary. 

Probably no book in which so many diseases are treated 
of, has so few remedies recommended. This has been done 
for the purpose of habituating my readers to the use of no 
more remedies than they could readily remember the quali- 
ties and uses of. I have recommended all that I thought es- 
sential, and although there are many left out, I believe the 
number is as great as would be thought necessary by the most 
celebrated practitioners of the day. 

Profoundly grateful that I have been spared, and am allow- 
ed the privilege of sending to the press the last sheets of my 
work, I console myself with the belief, that if it has merit, it 
will be discovered without a prolonged introduction. Nor 
will I conceal the apprehension, that there are man}' who 
would consider any introduction I might write, as the inter- 
ested production of one who felt a deeper interest in the sale 
of his book, than in the advancement, of science, or the good 
of mankind. Hoping that a work which has cost me much 
thought and labor, will prove valuable in the hands of many, 
I commend it to that people, who have ever extended to me 
a generous confidence. 

TOMLINSON FORT. 



INDEX 



PAGE. 

Abscess, - - - - - - 534 

Adhesive plaster, - 688 

Ague and fever — Intermittent fever, ^ - 137 

Alcohol, ------ 689 

Aloes, ------ 091 

Alum, ------- 691 

Amaurosis — Palsy of the eye, - 230 

Ammonia, ------ 693 

Antimonial mixture, - 721 

Antimonial powders, ----- 722 

Arsenic, ------ 692 

Arsenical solution, - - - - - 692 

Asafetida, ------ $93 

Asthma — Phthisic, ----- 270 

Balm, ------- 694 

Balsam of copaiba, - 699 

Bites of serpents and spiders, - 571 

Bilious Remitting fever, 64 

Bleeding at the nose, ----- 533 

Bleeding from the lungs, - 277 

Bloody urine, - - - - - 601 

Black hellebore, - - - 695 

Blue stone, ------ 695 

Borax, ----.. 696 

Boil, ------- 561 

Bronchitis — Inflammatory catarrh, - 260 

Burgundy pitch, - - - - - 696 

Calomel, ------ 7^9 

Calomel and jalap, ----- 723 

Cancer ------ 547 

Carbuncle, ------ 563 



VIII INDEX. 



PAGE. 

Cachexia, - - - - - - 595 

Camphor, - - - - - - 696 

Castor, 697 

Castor oil, - .... 697 

Cataplasms, - 69S 

Cathartics, - - - - - - 698 

Catalepsy — Trance, - - - 515 

Chicken pox, ------ 183 

Child-bed fever, 637 

Cholera morbus, - — - 363 

Cholera in infants, - 366 

Clergyman's sore throat, - 245 

Constipation — Costiveness, - - - - 405 

Colic, 347 

Cold— Catarrh, - - 251 

Croup, ------- 254 

Cubebs, ------ 700 

Delirium tremens — Insanity from drink, - - 207 

Definitions, - - - - - 727 

Diarrhoea, ----- - 392 

Diabetes — Excessive discharge of urine, - - 472 

Diseases of the breast, - - - - . 644 

Diseases of the cascum, -'--.- 400 

Diseases of females, - 627 

Diseases of the spleen, ----- 458 

Diseases of the kidneys, - 463 

Diseases of the liver, ----- 450 

Diseases of ihe skin, - 678 

Diseases of the nervous system, - 4S5 

Diseases of sensation, - 612 

Diseases of the brain, ----- 201 

Diseases of the lungs, - 249 

Diseases of the eye, ----- 220 

Diseases of the heart, - 308 

Diseases of the veins, ----- 315 

Dispensatory, ----- 688 

Dropsy of the brain, ----- 210 

Dry cough, - 268 

Dropsy of the abdomen, - _ - - 425 

Dropsy, ------ 476 

Dyspepsia, - » - - - 325 

Dysentery, ------ 384 

Ear ache, ------ 232 



INDEX. IX 

PAGE. 

Eating cancer — Lupus, - - - 5o „ 

Emetics, - - - - - - 700 

Epidemic cholera — Asiatic cholera, - - 377 

Epilepsy — Convulsive fits, - 486 

Ergot, ------ 701 

Eruptive fevers, ----- 150 

Ether — sulphuric, ----- 702 

Ethers, ------ 701 

Excessive sensibility, - 613 

Excessive menstruation, - 631 

Face ache — Tic douloureux, - 519 

Fever, -- - - - - -1 

Bilious remitting, 64 

Child-bed, - - - - - 637 

Eruptive, ----- 150 

Inflammatory, - - - - - 198 

Malarious, ----- 56 

Scarlet, - - - - - 172 

Typhoid, ----- 4 

Yellow, - - - - - 58 

Flooding, ------ 642 

Foreign bodies in the wind-pipe or lungs, - - 286 

Foreign bodies in the intestinal canal, - - 433 

Fractures, - - - - - - 663 

Fracture of the skull, - 664 

Fracture of the arm, - - - - - 664 

Fracture of the thigh, - 665 
Fracture of the leg, ----- 667 

Freckles — yellow spots, &c, - 686 
Galls — of the oak, ----- 702 

Gamboge, - - - - - 703 

Gangrenous sore mouth, - 243 

Gentian, ------ 703 

Giving suck, - - - - - 643 

Gout, ------ 530 

Gonorrhoea — Clap, - 653 

Gum Arabic, - 704 

Hemorrhage — Bleeding, - 599 

Hiccup, - - - - - 598 

Hooping cough, - - - - - - 274 

H\ T pochondria, ----- 521 

Hysterics — Hysteria, ----- 506 

Hydrophobia — Canine madness, - - - 586 

H 



X INDEX. 

PAGE. 

Inflammation, - - - - 184 

Inflammation of the iris, - - - ~ 228 

Inflammation of the mouth, - - * - 234 

Inflammation of the stomach, - 318 

Inflammatory fever, - - - - 198 

Inflammation of the Dura Mater, - 202 

Inflammation of the brain, --"-..- 203 

Inflammation of the eye, - 220 

Inflammation of the bowels, - - - - 415 

Inflammation of the peritonaeum, - 421 

Inflammation of the lungs, - - - 2S9 

Influenza, ------ 266 

Incontinence of urine, - - 606 

Intolerable itching — prurigo, - 683 

Iodine, -- - *" - - - - 704 

Iron, 705 

Itch, - - - - - - 685 

Jalap, - - - - - 706 

Jalap and cream of tartar - 723 

Jaundice, ------ 456 

Kino, ------ 706 

Lapis calaminaris, ----- 707 

Laudanum, - - • - - - 725 

Leprosy, - - 684 

Lime, - - - - - 707 

Locked-jaw — Tetanus, - - - - 495 

Lunar caustic, - - - - - 708 

Luxation of the shoulder, - 668 

Luxation of the elbow, -. 669 

Luxation of the hip, ----- 669 

Luxation of the ankle, - 670 

Mad itch — Nettle rash, ----- 580 

Magnesia, - 709 

Malarious fever, - - - - - 56 

Mercury, - - - - 709 

Measles, - - - - - - 178 

Mesmerism — Animal magnetism, - - - 622 

Milk sickness— Trembles, - 569 

Miliaria, - - - • - - 641 

Mixtures, pills, &c, - - - - 721 

Mumps, ____-- 555 

Muriatic acid, - - - - - 711 

Nightmare — Incubus, ----- 569 



INDEX. XI 

PAGE. 

Opium, ------ 712 

Pemphegus, ------ 678 

Piles — Haemorrhoids, ■---.- 410 
Pills, various kinds, - 724-5 

Pink root, - - - - - - 715 

Pleurisy, ------ 289 

Plague, - - - - - -.535 

Pneumonia, - - - - - 289 

Potash, - - - - - - 714 

Poisons, ------ 588 

Powders of ipecac and nitre, - - - 723 

Pregnancy and its diseases, - 634 

Pulmonary consumption, _ - - - 278 

Purples, - - - - - - 567 

Quinia, ------ 716 

Quinsy — Inflammation of the throat, - - - 603 

Red gum, ------ 683 

Rheumatism, - - - - - - 526 

Rhubarb and magnesia, - 723 

Ring worm and Barber's tetter, - 682 

Roseola, - - - - - - 1S2 

Saltpetre, - - - - - - 711 

Sage, - - - - - -. - 717 

Salivation, ------ 577 

Saint Anthony's fire — Erysipelas, - 557 

Saint Vitus' dance, ----- 503 

Scalds and burns, ----- 659 

Scarlet fever, ----- 172 

Scurvy, - - - - - 564 

Scrofula — King's evil, - 536 

Scrofulous sore eyes, ----- 226 

Senna, ------ 717 

Shingles, ----- 679 

Simple ointment, ----- 725 

Sleep walking, ----- 617 

Small pox, ----- - - 151 

Spirit of turpentine, - - - 718 

Squill, -1 - - - - - 717 

Stings of wasps, bees, &c, - 575 

Sugar of lead, - - - - - - 718 

Suppression of the menses, - - - - 628 

Sulphur, - - - - - - 719 

Surgery, ------ 663 



XII INDEX. 

PAGE. 

Sweet spirit of nitre — nitric ether, - 702 

Syphilis — Pox, - 649 

Tartar emetic, ------ 720 

Tetter, ------ 680 

Toothache, - - 675 

Toe nails growing in the flesh, - 674 

Typhoid pneumonia, _____ 302 

Typhoid fever, ----- 4 

Ulcers, --- = -- - 670 

Uva ursi, - - - - - 721 

Vaccination, - - - - - - 166 

Venereal disease, - 646 

Vomiting of blood, ----- 429 

Warts and corns, - - , - - - 673 

Weights and measures, - 736 

White swelling, ----- qqj 

Wounds, -----_ 675 

Worms, ------ 435 

Yellow fever, - - - - - - 58 



FEVER. 



When it is considered that almost every disease is at- 
tended with fever, and that a great portion of mankind are 
cut off by this disease, in some of its forms, the importance 
of its study will be duly appreciated. 

In what I shall say of this subject, I shall avoid as far as 
possible, the endless discussions to which it has given rise. 
Two important questions demand our consideration — how 
shall we avoid ; and how cure, this common and fatal disease ? 
Every one will acknowledge,, the paramount importance of 
these considerations, and I shall endeavor to keep them con- 
stantly in view. 

On a subject so familiar, it will naturally be expected, that 
I shall present the established opinions and practice of the pro- 
fession ; but alas, what a wilderness of opinion, what a thorny 
waste of practice, should I set forth ! The subject has always 
been full of difficulties, and the investigations of the day have 
rather increased than lessened them. Every thing is believed, 
every thing disputed. 

At the threshold, we meet with a question as unexpected as 
it is difficult. What is fever ■? "If a person, prostrated and 
in bed, with a burning forehead, flushed countenance, full and 
bounding pulse, acute pain in the head and limbs and great 
restlessness and thirst," were examined by a thousand per- 
sons in succession, every one of them would pronounce him 
to be laboring under fever ; but writers assure us/that there are 
fevers in which not a single one of these symptoms is pres- 
ent; and that a definition founded on all or any part of them 
is imperfect. My own opinion is, that fever is a disease of the 
whole system, always affecting the circulation of the blvK>d, 



FEVER. 



and the production and distribution of the heat of the body. 
That the heat should be lower, and the pulse less frequent at 
some periods, or in certain stages of fever, than in health, does 
not invalidate the fact, that in all fevers a disordered pulse and 
increased heat of the skin, may be securely reckoned on as 
symptoms. The exceptions to this, so far as my observation 
goes, are only in the chill stage of intermittents, or in a stage 
of prostration which attends the most malignant cases of other 
fevers. But in all these, if the patient is not cut off too sud- 
denly, what has been termed a reaction follows, with the 
quickened pulse, and increased heat of ordinary fever. Of all 
the diseases which I have seen, scarlatina presents the hottest 
skin ; yet in the most malignant cases of this complaint, I have 
seen a cold surface and feeble pulse, from the commencement 
to the fatal termination. Can it be proper from these half de- 
veloped cases, to say that scarlet fever is not attended with 
extra heat of the surface ? Prostration of strength, appears to 
me, an equally uniform attendant on fever. That a patient in 
delirium may exert extraordinary strength, is no more an ex- 
ception to this rule, than convulsions, which give to the mus- 
cles a force, much beyond the voluntary powers of the pa- 
tient. These symptoms, like the cold skin and slow pulse 
present in other cases of fever, last only a short time, when 
they are followed by the prostration of strength which char- 
acterizes the disease. There are consequently three symp- 
toms present in all fevers — prostration of strength — increased 
heat of the surface, and increased or disordered pulse. These 
symptoms are not present at every moment of every case, but 
not a single case can progress to a regular termination without 
them. 

It is not for the physician, and much less for another, to per- 
ceive at once the nature of every fever he meets with. He 
must take time for observing further developements, and form 
his opinion on grounds of proper judgement. A chill may 
give sufficient assurance of succeeding fever ; but I have been 
called in cases of scarlet fever when a cold surface, total pros- 
tration of strength and almost imperceptible pulse gave suf- 
ficient evidence of impending death, but none of the nature of 
the disease. The science of medicine is yet in its infancy. 

The simple elements of fever, do not signify equal simpli- 
city in its symptoms and consequences. Its classification has 
never been agreed on, and with a strong desire to avoid inno- 
vation and present the science of medicine as it is, I am una- 
ble to find any acknowledged authority on this subject. 



FEVER. 



Two grounds for a classification of fevers have been chiefly 
occupied ; one founded on the differences of their remote cau- 
ses, and the other on their symptoms or grades of violence. 

The classification founded on the present symptoms is at- 
tractive, because it seems to place the physician and his pre- 
scription in a scientific relation to the disease. It has many 
advocates, but the objections to it are strong. The greatest 
objection is that according to this division of fevers, the same 
disease will in a few days run the whole round of the nomen- 
clature. It may be inflammatory to-day, synochus to-morrow, 
typhus the next day, and intermittent or bilious all the while. 
This classification is made from the grade, and not from the 
kind of fever. In this way practical writers have allowed their 
minds to be confused, and the value of their works has been 
greatly lessened. 

The classification of fevers which I would approve, must be 
founded on their essential differences; and these cannot be 
known by the symptoms present at a particular moment. 
These differences bear an invariable relation to their remote 
causes — the fever of small pox is essentially different from that 
of measles — that which originates from malaria is essentially 
different from the typhoid; and these diseases can never change 
from one to another. Arising as they do from causes essen- 
tially different, the fever which ensues is in every case such as 
can arise from that cause alone. This may not at all times ap- 
pear evident, but taking every case in its whole course, it will 
be easy to distinguish it from any which may arise from an- 
other cause. 

It is my great object so to describe fever, that the reader 
will readily assign each case which may occur, to its appropriate 
class. This would seem to be a task of no great difficulty, but 
seeing in the attempts of others, any thing rather than a tolera- 
ble degree of success, I must expect to share the same fate. 

There is another question which has given rise to its parties, 
and its contests. Is fever an original or secondary disease? 
Does it arise from some pre-existing local disease, or is it of 
itself an original disease? My opinion is, that malarious, ty- 
phoid, and contagious fevers arise without any previous local 
disease, but that inflammatory fevers do sometimes arise as a 
consequence of local inflammation. 

The minute differences which exist in various kinds of fever 
are not appreciable by us ; but there is no doubt that each kind, 
is absolutely different from every other. Between the fevers 
which usher in small pox, scarlatina and measles there is not 



TYPHOID FEVER. 



always a visible line of distinction ; but each has its peculiar 
character and tendency. Nor are other fevers as readily recog- 
nized as might be desired. A physician finds his patient la- 
boring under great heat, prostration of strength and rapid pulse, 
but whether the case is to result in typhoid fever, or some of 
the eruptive fevers, is at first uncertain. 

Lat« and minute investigations have raised a doubt, whether 
every fever does not tend to a lesion or special disorder of some 
internal or external organ. The eruptive fevers, especially 
small pox, seem to be operations on the system, to bring out an 
eruption on the skin. In other diseases the eruption is equally 
present, but in some cases very insignificant. The eruption on 
the lips in intermittent fever, is scarcely of less consequence 
than the sudamina, and petechiae of typhoid fever. Now, these 
eruptions, which have of late excited so much attention, were 
heretofore so little noticed or regarded, that [ confess I have 
paid almost no attention to them. They are now regard- 
ed as pointing out the particular character of fever, and 
by their appearance denoting the stage of the disease, and its 
probable termination. 

I believe it would be impracticable to treat of fever, with- 
out dividing it into classes, and 1 regret that no division has 
been made, which has met with general acceptation. I shall 
choose that which appears to me, most simple and useful. 

I shall consider fever under the following heads : 
1st. The Typhoid, 
2nd. The Malarious, 
3rd. The Contagious or eruptive and 
4th. The Inflammatory. 

Without desiring to recommend this division to the adoption 
of others, 1 only ask for it so much attention as to bear it in 
mind, as the organization given to the subject in this work. 



TYPHOID FEVER. 

GENERAL REMARKS. 

Tfis is a continued fever, characterised by great prostra- 
tion of strength, and may continue a few days only, or extend 
to many weeks. The forms under which it has been seen 
are so various, that it has never been decided whether there 
are several distinct varieties or not. Equal uncertainty rests 



TYPHOID FEVER. 

on the question, whether it is, or is not contagious, or whether 
there is one variety which is contagious, and another not. 

I shall not attempt to settle these controversies, or dispute 
the facts recorded by others ; but place the subject as I have 
seen it, beiore my readers. If the facts 1 have witnessed are 
of any importance, it will be seen by those placed under cir- 
cumstances to profit by their stud}^ My observations have 
not been made in large hospitals or crowded cities ; but while 
they have thus been restricted to a smaller number of cases, 
they have had the great advantage of extending over a wider 
surface of country, and admitting of a better investigation of 
the circumstances under which the several cases have occur- 
red. On this account, I think the bearing of the facts I shall 
state on the causes and character of typhoid fever, is ve- 
ry important. On the questions of contagion and the means 
of putting a stop to the spread of this disease, I must be indulg- 
ed in saying, that I think the views presented are of the great- 
est value. 

Writers of unquestionable talent, have described typhoid 
fever, as a disease frequently prevailing as a general epidemic, 
and depending on some unknown cause. Others on the same 
field of observation, pronounce the whole, the effect of conta- 
gion. Others teach us, that the milder forms of typhoid fe- 
ver are not contagious; but that a more violent disease which 
they denominate typhus, is contagious. I am told, that cer- 
tain teachers in our medical colleges say that typhus and Ty- 
phoid fever are diseases unknown at the South. 

I shall not answer or reply to these statements and opin- 
ions ; but state my own as concisely as I can. 

1. Typhoid fever is never epidemic in Georgia. I have 
seen the disease every year, for thirty-five years, and always 
witnessed its locality in certain neighborhoods or on single 
plantations. 

2. A fatal, typhoid pneumonia, an extremely rapid disease 
in its progress, and differing widely from common typhus, 
has prevailed several winters at the South, under the name 
of cold plague. 

3. Typhoid fever is never contagious in Georgia, and I 
doubt its being so elsewhere. 

4. The cause of typhoid fever cannot be carried from 
place to place by infected persons. There is no danger to a 
family in receiving one ot its members, who has contracted 
the disease abroad. 

«L Whatever the cause of this disease may be, it attaches 



6 TYPHOID FEVER. 

itself to places, and is very slowly removed by a free exposure 
to air and light. A house thrown open every day, and having 
every article of furniture washed and exposed to the sun for 
weeks may yet have the infection, so that a person sleeping a 
single night in it, will contract the disease. I have seen this 
the case in certain rooms of a house, while the rest of the build- 
ing and its inhabitants remained unharmed. 

6. I make no distinction between typhoid and typhus fe- 
vers. For a long time, I believed that there was in higher lati- 
tudes "a mortal contagious typhus," which had never reached 
the South. I have lived to witness typhoid fever which had a 
violence equal to the most exaggerated statements I had read ; 
but it differed only in degree from what I had before seen, 
and was never contagious. I therefore suspect that these dis- 
tinctions of authors, will be found without a corresponding 
difference in this disease. 

CAUSES OF TYPHUS. 

Where men are crowded together for rest and sleep, without 
sufficient ventilation, typhoid fever spontaneously appears. 
It is the disease produced by human effluvia. It attacks the 
youthful, healthy, and robust, in preference to the diseased, 
the immature or the feeble. Youth and vigor are its chosen 
victims, and it is a great mistake to think that high health can 
delay its attack. 

The causes of typhoid, and bilious remittent fevers, stand 
opposed to each other. Typhoid fever arises from a poison 
generated in human bodies — it is the scourge of crowds in 
houses, in jails, in ships, and in cities. It attacks the mature, 
the healthy, and the vigorous ; leaving unharmed the child, 
the invalid, and the aged. The malarious or remittent fever, 
like the savage of the wilderness, spares neither age, sex, nor 
condition. It attacks the hardy pioneer in his cabin, the plan- 
ter in his country residence, or the citizen who resides in the 
suburbs of a city or town. Its cause originates from the vege- 
table kingdom — in the open fields, the tangled jungle, or the 
slimy bottom of the drying pool. The two diseases are sel- 
dom found together. 

I have said that typhoid fever has never prevailed as a 
general epidemic in Georgia. It has been roundly asserted 
that the disease has often spread over Europe from some un- 
known cause. In the accounts I have read of those epidemics 
I have seen no exception to the views I have taken. The 



TYPHOID FEVER. 7 

cause of this disease is the same in Europe that it is elsewhere. 
It is thought to be a disease of winter and to follow armies. 
Our army in Mexico, is said to be suffering from it at this time. 
Now what causes men to crowd together more than cold 
weather, and what adds more to the same cause than an in- 
vading army ? How could the great armies of Napoleon in 
his wars, escape it? They were quartered on every nation, 
and suffered with this disease, as a common pestilence. 

It cannot be denied, that there will occasionally occur ca- 
ses of fever which cannot be traced to any of the causes we 
shall assign for typhus, and yet have all the symptoms of 
that disease. There is but little doubt that cases sometimes 
arise from a peculiar tendency of the person to the disease, 
but it will often appear on an investigation that the case has 
arisen from the common cause ; a crowded, residence. 

This subject is too important to be dispatched with a few 
facts or assumed statements. The facts which have come 
under my own notice seem to me worthy of being considered 
more at large. 

It is often important to ascertain the character of a fever 
without taking too much time in the investigation. The first 
and most important question is, whether the disease is continu- 
ous and typhoid, or bilious and remittent. The circumstances 
under which it has arisen, will almost decide the question. — 
Bilious fever is the product of warm weather, operating on 
widely exposed surfaces of drying lands; it arises in the coun- 
try, or thinly peopled suburbs of towns or villages. Typhoid 
fever is regardless of wet or dry, heat or cold, but happens to 
those least exposed to the dews of night, and who sleep in a 
confined air in crowded rooms. The poor are its victims, but 
it attacks the healthy, robust, and young. It seldom attacks 
the aged and infirm, or the child under seven years old. — 
These circumstances point to the probable character of fever, 
but the investigation should not stop here, we must not be sat- 
isfied with mere probabilities. 

INFECTION OR CONTAGION OF TYPHUS. 

My opinion on this head has been expressed, but the grounds 
of it may be more fully developed. The terms infection and 
contagion are loosely used by medical writers. Both mean 
the propagation of disease from the sick to the well, but wheth- 
er by contact or by near approach without contact, or which 
of these words means one, or the other, is left in great confu- 



8 TYPHOID FEVER. 

sion. Typhus fever is by most writers thought to be commu- 
nicable, either by placing the healthy near the sick or in con- 
tact with them. Contagion is the word now commonly used to 
indicate either or both of these modes of propagating diseases, 
and I shall so use it in this essay on typhus. 

The first question which it becomes necessary to discuss, is 
the very important one — is typhus fever contagious 6 ? It would 
seem to be rash in the face of the thousands of examples given, 
to deny that the disease is contagious. It is unsuited to the 
nature of this work, to enter fully into the discussion of this 
question ; I will leave it where I found it in regard to the ex- 
perience of others, but state for myself that typhus fever in 
none of its forms, has ever seemed to be propagated by conta- 
gion, where I have seen it. I therefore give the opinion that 
typhus fever never is contagious. Some of the facts I have wit- 
nessed will be brought forward in support of this opinion. 

That the bearing of the facts I shall adduce, on the question 
of contagion, as well as on the equally important one, of what 
circumstances produce the cause of typhus, may be seen, I 
will here in the first place state the facts which I think are al- 
ways present, where typhus fever originates. The origin 
and cause of the disease rest on a single fact, viz, too many 
persons crowded and sleeping in too small a space. A great ma- 
jority of the cases of this disease, which will be met with, will 
at once be seen to have arisen in situations particularly crowd- 
ed ; but I will not deny that I have met with cases for which 
I could assign no cause whatever. 

With these remarks we are prepared to discuss the ques- 
tion of contagion. It has always been observed, that if ty- 
phus is contagious, the infection is of limited activity, for the 
disease never spreads like small pox or measles in a commu- 
nity. It has therefore, been suggested, that the contagion ope- 
rates only to a very small distance, and that its activity is then 
modified by some unknown influence of the atmosphere in the 
place in which the disease is propagated. This is assuming 
a great deal too much, and in my opinion is an unfounded hy- 
pothesis. 

I believe the disease is not contagious, from the following 
facts : 

1. For thirty years and more, I have been in the habit of 
giving professional attention to the sick with typhoid fever. — 
In all that time, I have never passed a single year without see- 
ing the disease, and have visited its victims under every varie- 
ty of circumstances, without being attacked by it. 



TYPHOID FEVER. iJ 

2. During the same routine of experience, I have witnessed 
the visits of the friends of the sick, performed with equal safe- 
ty. It is within bounds to say, that I have seen the sick visit- 
ed in this way, a thousand times, without harm to a single visi- 
tor, who but made his visit and returned in a reasonable time. 

3. I have in many cases advised the removal of the sick, du- 
ring any part of the progress of the disease, and have never 
known it to spread in the families of those who opened their 
doors for the performance of this great act of humanity. Now 
according to my view of contagion, the removal of the sick into 
the houses of the well is the best method of giving opportunity 
for its action, and if typhus fever cannot be propagated in this 
way, it is not contagious, 

How then is the virus of typhoid fever produced ? I have 
stated above that there is one circumstance always present at 
its production, viz, too many persons crowded and sleeping in too 
small a space. It is conceded that cases are often met with, in 
which the application of this rule cannot be easily seen. — 
These cases are almost always of a mild grade, and appear 
in persons of peculiar susceptibility. They are met with 
by every practitioner, and are called by various names ac- 
cording to their particular symptoms. The physician will 
say, it is a continued fever, a typhoid fever, an inflam- 
matory fever or something of the kind, and in two or three 
weeks the fever subsides without extending to others. These 
cases never, so far as I have seen, originate in persons residing 
alone; and I think they are produced by a cause which ope- 
rating equally on others, but finding in them less suscepti- 
bility to the disease, produces no effect. 

But when typhus fever becomes formidable, it will always 
be found to have originated at a point on which numerous 
persons had been concentrated, for the purposes of rest and 
sleep. This fact, so important to be known, cannot be placed 
on evidence too clear; for it puts it in our power to hinder the 
origin, and to arrest the progress of this formidable disease. 

For obvious reasons the colored population in countries hold- 
ing them as slaves, and the poor in all countries, are most sub- 
ject to typhus; not that they are unprovided with the neces- 
saries of life, but that their habitations are too densely peopled. 
This will be made obvious by the following facts. 

The first cases of typhus which I was called on to attend, 
occurred in the family of a white man. His numerous chil- 
dren had grown up to manhood, and although he was not 
very poor, they all resided in a single small tenement. I found 



10 TYPHOID FEVER. 

four or five young men and women, in the same room, labor- 
ing under a high grade of typhus fever. The father and mo- 
ther of these people, were not attacked with the disease ; one 
of the children died, and another was left with a partial para- 
lvssis from which he never recovered. Alarm and the fear of 
infection, cutoff from this poor family the hospitality of friends, 
with a single meritorious exception. Alady? residing within a 
mile, visited and assisted in^heir affliction, and staid with them 
many nights. She was attacked with the disease, returned 
to her residence, and was cured. The disease spread no far- 
ther, but I had now seen what I have often since witnessed, 
that typhus fever originates, where persons are most thickly 
crowded together ; that it is not communicated to the mere 
visitor by dfij, but that it will attack the nurse, or the friends 
who expose themselves, by day and night, to the same cause 
which produced the disease in the first instance. 

A tew days ago I was called on by an elderly man, who re- 
minded me of having visited him, twenty-five years ago in 
typhus. His father, then a man of mature years, had a fami- 
ly of children grown, or nearly so. They had lately removed 
to a new residence, and for want of sufficient buildings, were 
crowded into a small tenement, with a floor of earth or rather 
of sand. All looked dry and new, but the sick were strewn on 
every side. Two had already died, and there remained only 
three, who had thus far escaped the fever. 

Seeing the high grade of the disease, and believing the place 
to be thoroughly infected, I advised the instant removal of 
every one, to the nearest convenient place. Through the cre- 
ditable humanity of the neighborhood, and my assurance of 
the safety of the operation, places were procured for all, and 
ail recovered with uncommon rapidity. 

Similar facts are more frequently observed amongst our 
colored population. A man with his wife and child are fur- 
nished by their owners with a single tenement, twelve, or per- 
haps sixteen feet square. At the end of sixteen or eighteen 
years, he is the father of a large family, all of whom are crowd- 
ed into the same small house. They are now in imminent 
danger of having a fatal typhus fever break out amongst 
them. Two years ago, I was called to witness a case of this 
kind. It was on the plantation of a wealthy planter, whose 
own residence was nearly encircled by the tenements occupied 
by sixtv or seventy slaves. In one of these tenements two 
months before my visit, a fatal Typhus had made its appear- 
ance. Four of its inhabitants had died before I was called to 



TYPHOID FEVER. 11 

witness the progress of the disease. My residence being at a 
considerable distance I was not called on, till the ravages of 
the disease, and the number of the sick, gave to every thing 
the appearance of an awful pestilence. The disease had now- 
extended to the adjoining houses, and the cases now number- 
ed about fifteen. 

My attention was first directed to the house in which the 
disease .originated. It was an old tenement, whose wooden 
blocks having given way, the floor had settled to the ground ; 
the chimney, broken off about mid-way, was covered with 
boards, and the walls made perfectly close by being daubed 
with clay mortar. The sick family had resided but a short 
time in this house ; and their energetic and care taking owner, 
had not had time to provide them a better. The residents 
consisted of about ten persons, all of one family, the youngest 
about ten years old. This family were laborers in the field, 
and it was their daily practice, to rise in the morning, close 
and lock up the house, and to return only at night to open it for 
a short time, then close and sleep in it till morning. If from 
the convenience of their labor it was practicable for them to 
return at noon, the house was then for an hour or two opened. 
Every appearance of a full supply of the necessaries of life to 
those people was manifest ; but the organization I have de- 
scribed, placed them every night in this small building, with- 
out ventilation through the floor, through the wall, through the 
door, or even by the chimney. 

The disease made its appearance in February or March, 
progressed slowly, and destroyed one by one, so that by the 
20th of May when I was called, several had died. No fear of 
contagion had been entertained, and the same system of im- 
perfect ventilation prevailed. The nurses and friends of the 
sick thronged the house still more, and the disease had as- 
sumed a malignity greater than 1 had ever before witnessed. 

Nurses and visitors who attended the sick, and staid with 
them at night, were attacked, and in this way cases happened 
in the neighborhood ; but in no instance did the disease spread 
into the families it was thus introduced into. Every case in 
the adjoining tenements might be traced to the same cause, and 
although the disease extended to thirty or more persons, I 
think not a case happened from any other source of infection. 

The disease according to its habit, and character, attacked 
youth and manhood, but made no impression on childhood or 
age. It went on till it had destroyed nine out of about sixty, 
and their owner assured me, that there were not left nine 



12 TYPHOID FEVER. 

more of equal value, activity, vigor, and intelligence. So vio- 
lent had it become, that about the first of June, a young girl 
presented herself as just attacked — her pulse was almost too 
rapid for numeration, and she was a corpse in less than two 
days. At the same moment, I beheld in every house, the 
pleasing yet melancholy sight, of a large number of small chil- 
dren, some left orphans by the pestilence, but all enjoying un- 
interrupted health. 

The owner of these slaves, I have said lived as it were in 
their midst. The house of which I have said so much, was with- 
in forty yards of his residence, and none of the rest of the negro 
houses much farther. He was a devoted master, and gave 
himself up to the service of the sick, by night and day. His 
wife, overseer and one or two other white persons did the 
same, and were exposed to the poison of the disease, as much 
as the negroes, except that they did not remain long in the in- 
fected houses, and never stopped to rest or sleep there. No 
white person was attacked by the disease. 

The weather which prevailed during the progress of this fatal 
disorder, was exceedingly hot and dry : there seemed not to 
be moisture to support the slightest putrefaction, and nothing 
which I could discover bore the slightest evidence that there 
was such a thing as a putrefactive process. The blazing sky, 
the burning heat of the sun, the stunted and withered corn, the 
dusty road and the dry and parched ground, presented a spec- 
tacle of heat and drought which has seldom been surpassed in 
this country. Yet in spite of this state of things, typhus fever 
which has been thought the disease of cold climates, prevailed 
with a violence and malignity which has seldom been surpas- 
sed. These facts go to support the opinion that this disease 
does not arise from the sensible qualities of the atmosphere, or 
from the process of putrefaction. 

The importance of this subject justifies the detail of some 
more facts which I have observed in regard to it. Two years 
ago I was called to a neighboring plantation, to prescribe for 
two cases of typhus fever which had just occurred. It was at 
the plantation of a gentleman who had lately obtained a con- 
siderable addition to the number of his slaves, had erected 
new houses for some of them, and it was in one of the new 
houses, that the two cases of fever occurred. The two pa- 
tients were sisters of fourteen and sixteen years of age ; — the 
house was a comfortable double cabin with a wide entry, but 
the two ends were occupied by different families. Every 
thing was as sound as it could be, the house was several feet 



TYPHOID FEVER. 13 

elevated from the ground, and admitted in every way a free 
circulation of the atmosphere. I learned that the mother, and 
her five or six children, the smallest of which was now nearly 
grown, occupied the end of the house in which the fever had 
made its appearance. The mother also stated that as it was 
summer, the entry and the house was the common place of re- 
sort for many besides those who resided in it ; that she could 
not for these reasons, state the number who nightly slept in 
the building. 

These cases of fever were mild and terminated favorably 
in a few days. Vigorous measures w 7 ere taken to thin the pop- 
ulation of this new building, and the disease spread no farther. 

These details have been presented in support of the opinion 
I have expressed, that typhoid fever is produced by the con- 
centration of too many persons w r ithin a given space for the 
purposes of sleep and rest. It has been seen that the disease 
occurs as well in the new as in the old and decaying house, as 
w r ell in the house w*ith but the naked earth for its floor as in the 
most comfortable residence, and that the sole obvious fact 
w r hich is in every case present, is the presence of too many 
persons within a given space. 

It is agreed, that we known othing of the nature of the virus, 
or poison, which produces this disease. It has been suggested 
that it depends on some change in the quality of the atmos- 
phere and that it is moveable by the winds. This opinion is 
not sufficiently supported. The cause of this disease may, 
like magnetism or electricity, pass or remain, originate or dis- 
appear, without the slightest regard to the agency of t lie atmos- 
phere. I have witnessed many instances, in which the cause 
seemed not to be removed by a very free ventilation, and one 
in which the removal of persons, and the thorough ventila- 
tion of buildings had not removed it in three or four weeks. 

In the year 1836 there was at Midway, two miles south of 
Milledgeville, a labor school with about sixty pupils, who 
boarded and slept in a single building. The house was new 
and consisted of a brick basement story, surmounted by two 
stories of wood ; each story being divided into eight or ten 
rooms with a longitudinal passage running from end to end. 
In each of these rooms, which could not have exceeded twelve 
feet in diameter, there were from two to three pupils. 

The building stood in a direction nearly north and south ; 
and typhoid fever made its appearance in the rooms of the 
Nortli east comer, about the first week in July. The inmates 
of the rooms of the basement and two wooden stories, were at- 



14 TYPHOID FEVER. 

tacked at the same time. The cases with the exception* of 
two, were mild. I visited them within a day or two after 
the attack — found two of them quite ill, and the remaining 
five or six with very slight fever, and some tenderness of the 
abdomen, which was a leading symptom in all these cases. 
There were now resident in this house sixty pupils, and six 
had typhoid fever, all in three rooms in one corner, one above 
another. 

Fearing from the great number of pupils in this one build- 
ing, that the disease would spread and become malignant, I 
advised its instant evacuation ; but the mildness of the cases, 
was such that they produced so little effect on the minds of the 
trustees, or teachers, that my advice was not adopted. 

In eight days the disease broke out in the adjoining rooms, 
which were separated from those already mentioned by a thin 
board partition. We now had the disease in six rooms, all in 
the same part of the building, but in three stories, one above 
another. In another week the next three rooms were also filled 
with new cases, and the number of sick amounted to about 
twenty. 

The trustees were now called together, and they decided un- 
der my advice, to request the neighbors to take the sick and the 
well into their houses, and thus evacuate the building of its 
inhabitants. To give better assurance of my faith in the safe- 
ty of the operation, I took one of the worst cases into my own 
house, and the whole, sick and well were thus received into 
the families of a few liberal minded citizens. The house was 
thrown open by day, and a thorough cleansing with soap and 
water given to every thing it contained. For three weeks this 
process was kept up, and every article of bedding and furni- 
ture exposed repeatedly to the sun. 

After three weeks the pupils who had recovered, with all 
those who had not taken the disease returned to their rooms, 
and the school and its labors, were renewed. In four or five 
days the disease reappeared, in exactly the same rooms where 
it had left off. It now spread to the entire side of the house, 
but had not crossed the passage, in either story of the building. 
There were about thirty cases, and all occurred on one side of 
the house. 

The disease had now passed the entire length of the build- 
ing, and after five or six weeks crossed the passage of eight 
feet, and attacked two pupils at the opposite corner of the 
building, from where it began. It was considered unsafe to 
contend with it any longer, and the pupils were withdrawn 



TYPHOID FEVER. 15 

for the remainder of the summer. — They returned the next 
winter but the disease made its appearance no more. 

These facts are exceedingly curious, and correspond in a 
wonderful degree with all the observations I have had it in my 
power to make on this disease. They go far to sustain the 
proposition I set out with ; that typhoid fever arises from but 
one cause, viz too many persons crowded together in too 
small a space, for rest and sleep. They go far also in sustain- 
ing three additional propositions. The first is, that the cause 
of typhus fever thus produced continues in the place in which 
it originated, for a considerable time, after the persons who 
were affected by it have been removed. The next is that the 
cause is not affected by the movements of the atmosphere — it 
cannot be blown away or carried by the winds even a few feet. 
And we may add, that it is equally unaffected by the visible 
causes arising from the state of surrounding things, viz — its 
rise and progress is neither caused nor hindered, by heat or 
cold, wet or dry, — no decay of timber or of vegetable or ani- 
mal matter will produce it, nor is there any protection in the 
soundness or cleanliness of persons or things — there is but one 
protection and that is, to thin out the crowd of -persons. 

The locality of this infection in the school rooms is very re- 
markable. The disease occurred first in one corner of the 
building, in three rooms one above the other. Every inmate of 
these rooms was sick before any other person was attacked. 
In eight days the inhabitants of the next three rooms, separated 
only by a board partition, were in like manner attacked. At 
this rate it progressed along the side of the building, the entire 
length of the house, before it made its appearance on the op- 
posite rooms which were separated by a passage of eight feet. 
It was curious to see the entire exemption of one side of this 
eight foot passage in three stories of the building, and the uni- 
versal sickness which prevailed on the other side. The only 
exception was in the steward, who fell a victim to his labori- 
ous attention to the sick. His family escaped the infection. 
After six weeks the disease crossed this eight foot passage at 
the opposite end of the building from where it began. It was 
at the time suggested, that a trough in which some pigs were 
fed near the infected corner of the building might have been 
the nuisance which caused the fever. I examined it closely, 
and found nothing offensive about it. It was removed as 
soon as the disease made its appearance, but the progress 
of the disease was not stopped. 

We have here one of the thousands of examples of the 



16 TYPHOID FEVER. 

limit of the infectious causes of typhoid fever. It existed on 
one side of an eight foot passage, but not on the other; three 
steps removed the inhabitant from a place of danger to one of 
safety. This fact is here brought out in a prominent way, but 
it is not a solitary fact. I have again and again seen a single 
room in a house, the sole place of typhus disease, and every 
inmate of that room affected by it. It is reserved for chem- 
istry to furnish some test of the presence of the yet unknown 
cause of typhoid fever. What reward would equal the value 
of so great a discovery ? 

While writing, I have read from a public journal the fol- 
lowing notice. — " Fever is dreadfully prevalent, in Liver- 
pool ; it has made the most destructive havoc amongst the 
catholic clergy ; eight having been swept away in two months : 
the disease was in every instance contracted by them while 
visiting the sick." Similar notices have been published with 
regard to this disease in Europe during the whole time of my 
remembrance. I will not stop to discuss the question of con- 
tagion in reference to this disease in Europe. I remark that this 
paragraph contains no notice of the extension of the disease at 
the residences of these pious clergymen, and I am left to infer 
that although they contracted the disease by visiting and re- 
maining too long in infected districts or houses, they were not 
a cause of extending the disease in other places. This is in 
my opinion in strict conformity with the law governing the dis- 
ease, and I consider it an established fact. Had these clergy- 
men remained with the sick but a short time, making their 
daily visits from their own houses, they might all have escaped 
the infection. 

I am apprised that the circumstances which I have assigned, 
as the general cause of typhoid fever, have long been thought to 
produce it, in jails, ships and other points of crowded popula- 
tion. In these places the case has been too plain to be overlook- 
ed, but in other situations the same causes were less obvious, 
and a circumstance affecting all alike, a general constitution 
of the atmosphere, has been suggested and I think generally 
adopted. The great mischief caused by this opinion is that 
it attributes to a cause beyond our control, the ills which arise 
from causes which it is in our power to remove. 

I have said nothing of famine in connexion with the cause 
of typhoid fever. I have had no experience of this, and 
trust I never shall. In Europe I believe it is a general belief 
that typhoid fever arises from famine as one of its causes, and 
I will not dispute the correctness of the observation. But I 



TYPHOID FEVER. 17 

will not disguise the opinion that even where famine is added 
to the causes, it may derive its force from the concentration of 
human beings into crowded situations — the origin of the dis- 
ease may, in this case also, be the same. 

In any view I have been able to take of typhoid fever, I see 
in it, the hand of the great and the good Author of the uni- 
verse. Man may, from the vices of his institutions, the wars 
of his ambition, or his sloth or ignorance, crowd together to a 
degree forbidden by the laws of order, of morals, or of reli- 
gion ; but he is soon shewn his impotence; he is instantly 
smitten by this pestilence, which spares age and childhood, 
but cuts down youth and vigor, till the violators of these laws 
are no more. I have had no opportunity of observing this dis- 
ease, hovering, as it always does, around large armies, or in the 
narrow lanes of crowded cities ; but I can readily conceive the 
scenes of disorder which are there rebuked by its presence. 
But it is not armies and cities alone, which are punished by 
violating the great laws of order — a single family must provide 
for itself room for decency and order, or in due time, it will 
pay the penalty. 

Since writing the above, I have read the close argument and 
imposing facts brought forth by Doctor Watson in proof of the 
uniformly contagious character of continued, or typhoid fever. 
I am so strongly impressed with the dangerous measures, which 
this argument and array of facts, is calculated to enforce, that 
I feel bound to dwell yet a little longeron this subject. 

Doctor Watson says, when we see a disease arise "in a cer- 
tain spot, and gradually spread thence as from a centre, the 
presumption is in favor of its propagation from person to per- 
son;" again — " If we trace the fever among persons who have 
had intercourse with the sick, and more frequently in propor- 
tion as that intercourse has been close or continued ; and if we 
find that other persons, living in the same place, and under 
precisely the same circumstances, except that they have had 
no known communication with the sick, escape the fever; we 
have in these facts convincing evidence that the disease has 
been spread by such intercourse ; in one word, that it is con- 
tagious." 

The facts brought forth by Doctor Watson in support of 
this opinion are imposing, but I think, not conclusive. In the 
first place he says : " even in hospitals, where cleanliness is 
prized and enforced, that fever attacks many persons who come 
most often and most intimately in contact with those already 
ill of that disease;" he adds that, "The separation of a few 
2 



18 TYPHOID FEVER. 

feet, if due regard be had to ventilation, is sufficient to render 
the poison inoperative," but he continues, "It is only when our 
wards are unusually full offerer patients that these disasters oc- 
cur." A cloud of testimony is next adduced to shew the dan- 
ger to nurses and physicians who attend the sick, in these 
crowded fever hospitals ; all of which is unquestionably true. 

But the most interesting of the facts arrayed in this essay 
are to follow. I copy an entire paragraph. "Evidence of a 
somewhat different kind, but leading to the same conclusion, is 
to be found in the fact, that when persons, having the fever 
upon them, are transferred to some distant spot, that was 
previously free from fever, they frequently form centres 
from which the disease begins thenceforward to spread. It 
is imparted in this way even in the country, from family 
to family, and from village to village." Several instances 
are given by Poctor Watson to establish this fact. He 
points out cases in which an individual sick of fever, being car- 
ried into a house not before having it, the disease spread in 
the family of that house; and one of such a family being also 
sick going to another place, propagates the disease there also. 
So strong and incontrovertible are these proofs in the mind of 
Dr. Watson, that he is lost in astonishment at the fact, that a 
great majority of the physicians of Europe do not believe ty- 
phoid fever to be a contagious disease. He comes at last to 
the lame conclusion that men form their opinions in part from 
the particular constitution of their minds, and that in England 
the non-contagionists are mostly men who belong to a party ad- 
vocating " liberal opinions in politics and religion." 

This sagacious author is too candid to leave the sub- 
ject, without shewing the opposing facts relied on by oth- 
ers to disprove his opinions. He admits that the disease does 
not spread in the houses of the rich who have room, cleanli- 
ness, and ventilation — that visits to the sick ma}' be safely 
made if they are not too long protracted — that certain persons 
go unscathed in the worst sort of exposure — and that the 
disease often arises where there is no evidence of exposure 
to contagion. I will add (from Cyclopedia of practical medi- 
cine) the experience of Christison and Tweedie ; that among 
the numerous instances, " of young practitioners and medi- 
cal students who had caught fever, not a single case had 
occurred where the disease was communicated to their fami- 
lies at home or in their lodging houses." Shall I repeat 
that facts of this kind have happened under my own obser- 
vation again and again! 



TYPHOID FEVER. 19 

Now, what are we to say to this array of opposing facts ; 
what shall we do, that fever may be deprived of its victims? 
According to Doctor Watson's own showing, the contagion of 
this disease is so weak, that nurses and attendants may escape 
it by care, cleanliness, and ventilation — that in the hospitals of 
London — "It is only when our wards are unusually full of fe- 
ver patients," that the disease is propagated to the physician 
or the nurse. From these facts I infer, that the disease is 
caught in its place, and cannot be carried out and disseminated 
by persons who have it. And admitting the fact alleged, that 
the disease has, in a few rare instances, been propagated in fam- 
ilies by persons sick with it, being brought there for care and 
attention, it will appear altogether probable that these families 
were so crowded as to produce the disease from the same cause 
from which it might arise in other places. The wards of a 
hospital crowded with fever patients, would surely present an 
atmosphere as favorable to its propagation, as could be de- 
sired. 

The importance of settling this question properly will be 
seen, when the measures recommended by those entertaining 
different opinions are considered. Doctor Watson thinks fe- 
ver may be stopped, or narrowed down in its range, by send- 
ing those v/ho are attacked to hospitals, where he admits their 
concentration to be a great evil, and destructive of life, but less 
so than their dissemination in the community. Those who be- 
lieve the disease arises from a general atmospheric cause, deem 
all fear of increasing it idle, and all hope from removals vain. 
My own opinion is, that the means of preventing the spread of 
typhoid fever are almost always in our reach, and that for the 
want of a proper knowledge and practice of them, thousands 
perish who ought to be saved. 

Doctor Bancroft presents many facts to prove that a crowd- 
ed population alone is not a sufficient cause for the production 
of typhoid fever. He says, this disease is unknown in the 
arctic regions where of all places men live most concentrated, 
and least ventilated, and that slave ships are not apt to expe- 
rience it, even where their victims are dying from suffocation 
and crowding. These facts have not been sufficiently observ- 
ed, to stand as a refutation of others equally certain and op- 
posed to them. No one pretends to know the exact time or 
circumstances under which typhoid fever is produced. Every 
writer bears witness of the awful mortality which attends 
slaves in slave ships. Bat say they, it is diarrhoea, and not ty- 
phus which destroys them. What kind of diarrhoea is this? 



20 TYPHOID FEVER. 

May it not be the same I have seen in typhoid fever, where 
the first symptom was a copious discharge from the bowels; 
and a rapid succession of such discharges caused death in less 
than four days? 

I have endeavored to enforce a belief of two important prin- 
ciples in regard to typhoid fever. 

1. The first is, that it will arise where too many persons are 
collected together in too small a space, for the purposes of sleep 
and rest. 

2. The second, that the disease, when so caused, will not be 
contagious, and cannot be disseminated by the removal of the 
sick to places having sufficient room and ventilation. 

The first of these maxims points out the means of avoiding 
the cause and origin of the disease — the second enables us to 
limit its extension, and save a community or large family from 
its usual destructive course. This great good I have several 
times had it in my power to accomplish, and the measures I 
shall recommend, have in every instance in which I have seen 
them tried, succeeded perfectly. 

SYMPTOMS OF TYPHOID FEVER. 

Authors agree in attributing to typhoid fever certain pre- 
monitory signs; they say the nervous system is affected before 
the blood vessels. Most of these symptoms signify a debil- 
itated state of the mind, and body ; the patient is feeble 
and easily fatigued, and has great listlessness and sometimes 
timidity. In his movements he will frequently be so unsteady, 
that he will hardly be capable of pursuing a direct course from 
one place to another. On enquiry it will be found that his 
bowels are irregular, sometimes being affected with diarrhoea, 
but in other cases with costiveness; his tongue, along its centre, 
will be found covered with a thin white fur, and it will appear 
shrunken and pointed, and tremble when it is attempted to be 
shown. 

These symptoms are frequently so slight, as to escape the 
atteniion of the patient himself, his listlessness or inattention 
being such, that his being diseased is first noticed by others. 
I have several times, while attending families in which this dis- 
ease prevailed, noticed from the unsteadv movements and va- 
cant expression of persons who had not yet complained, that 
they were also attacked with the fever. On examining such 
cases, I have found the tongue already covered with a white 



TYPHOID FEVER. 21 

fur, the abdomen tumid and tender, and a considerable degree 
of fever already present. 

In numerous cases I have seen this disease come on with all 
the symptoms of a common cold, the sneezing, running at the 
eves and nostrils, paleness of the skin and copious discharges 
of lvmpid urine, were not to be distinguished from this com- 
mon disorder. These symptoms, when occurring in this dis- 
ease, have too frequently led to the use of remedies for an a- 
cute inflammatory disease; which, as we shall see, is a very 
injurious practice. All these symptoms, it will be recollected, 
occur in other diseases besides typhoid fever; they are there- 
fore to be studied in connexion with other circumstances which 
might render the attack of the disease probable. If they oc- 
cur for instance in a person who has been exposed to the same 
cause which has produced typhoid fever in others, it will be 
safe to conclude, that an attack of the disease has commenced. 
But if no such circumstances exist, the most experienced prac- 
titioner will find it prudent to withhold his opinion, till there 
is a further development of the case. 

In a great majority of the cases met with, the physician will 
not see the patient till the symptoms w r e have described have 
passed, and others of a more positive and formidable cht me- 
ter have shown themselves. Where the disease is prevailing 
in grades which are formidable, the attack is most frequently 
without any premonitory symptoms ; a slight shivering of no 
great duration takes place, and is followed by a regular onset 
of fever. 

The variety of symptoms which occur in typhoid fever, is 
not very great; yet they are not all present in any one case, 
and it is not always perfectly easy to decide on the nature of 
the disease^ The first symptom I shall mention is headache, 
or pain commonly across the forehead. This symptom is, as 
far as I have observed, always present; but as it occurs in other 
diseases it cannot be considered an unerring sign of the pres- 
ence of typhus. In its decree it is exceedingly various; some- 
times producing no intolerable pain, but in other instances, be- 
coming exceedingly- accute, and producing great restlessness 
and delirium. 

The state of the bowels is peculiar in this disease. In some 
instances diarrhoea is present from the first ; in others there is 
costiveness which prevails through the wmole disease, unless an 
opposite state is brought on by the imprudent use of cathartic 
medicines. When diarrhoea appears early in the disease, the 
discharges are copious and fluid, but net very frequent. The 



22 TYPHOID FEVER. 

matter discharged is offensive, with a peculiar, yellowish, clay 
color; and I have so frequently noticed the appearance of dark- 
specks, not larger than a grain of wheat, floating about in these 
discharges that I am obliged to think they are symptomatic of 
the disease. When the disease is attended with diarrhoea, 
there is almost always present from the first, some tumefaction 
and tenderness of the abdomen ; but the pain and inconveni- 
ence which attend it, are much less than we should be led to 
apprehend. 

The pulse in typhoid fever is sometimes so little disturbed, 
that it would not be easy to decide that the patient had any fe- 
ver at all ; and these cases are apt to be very obstinate, and 
perhaps the most protracted that occur. They are however 
attended with far less danger than cases in which there is 
more disturbance of the circulation. In other cases the pulse 
is feeble and rapid. Even at the onset of the disease, I have 
felt the pulse beat from one hundred and twenty to one hun- 
dred and thirty times per minute, and these cases I have so of- 
ten found to terminate fatally, that I have come to the conclu- 
sion that the danger of the disease is nearly in proportion to 
the rapidity of the pulse, at its onset 

Great attention has been paid to the force and rapidity of 
the pulse in this disease. Dr. Cullen made his principal di- 
visions of fever, to depend on the force of the circulation. 
Where the pulse was strong, and the heat considerable, the dis- 
ease was considered inflammatory, and remedies of a weakening 
or depleting nature, directed. Now, although the pulse in ty- 
phoid fever is sometimes in a considerable degree full and 
strong, it never has the force and fullness which attends it in 
disorders which are truly inflammatoiy. The peculiarity of 
the pulse in typhoid fever is, that when it increases in force it 
becomes lessened in frequency. This is certainly true in the 
first week of the disease, and I think commonly true during its 
whole course. As a general rule, it may be observed that if 
in the progress of the disease, the pulse grows rapid and fee- 
ble, the patient is getting worse; if on the contrary the pulse 
becomes slow and full, whether from the effect of remedies or 
spontaneously, the disease is getting better. This is an old 
remark, first made I think, by Dr. Darwin. 

The next symptom which I shall mention is the universal 
sign of fever — increased heat. This is not very remarkable in 
typhoid fever. In man}' instances the heat is not very great ; 
the hands or feet exposed to the air, become cool and even the 
face is frequently observed to be as cool,, as in ordinary health, 



TYPHOID FEVER. 23 

But at all times during the course of typhus, there is a mani- 
.fest increase of heat about the body. This will be manifest on 
a slight examination with the hand. The heat of the body is 
by no means uniformly the same; it varies as the pulse varies, 
but whether these variations correspond strictly with the state 
of the circulation, is a question I will not pretend to decide. 

In the regular course of typhoid fever, there seems to be a 
daily routine or evolution of disease. At some hour, in the 
course of the day, there will be seen on one cheek, a spot of 
red, sometimes not larger than a quarter of a dollar; this spot 
will gradually enlarge and so extend that the whole face will, 
in two or three hours, be flushed, and red. The heat of the 
body will be greatest at this time ; but the hands and feet will 
be found cool, and the patient will often call for warm applica- 
tions to them. In the course of five or six hours, the heat will 
be generally diffused, and the color of the patient's face begin 
to decline. After ten or twelve hours the heat will fully ex- 
tend to the extremities, when the application of cold water, 
will be as grateful as it would have been disagreeable, at the 
commencement of the symptoms w 7 e have described. The fe- 
ver at length subsides in some degree, but after a lapse of 
twenty-four hours or more from the lime of the appearance of 
the flushing and red spots, we have spoken of, the same symp- 
toms will be again renewed, and so pass through another period. 

In this manner, with but little change in its symptoms, ty- 
phoid fever passes through what has been called its first stage. 
This period is of uncertain duration and may last from eight 
to fifteen days or more. But at last, the patient runs into a 
quiet, easy, long continued perspiration, and in many instances 
the disease terminates here, and the patient becomes conva- 
lescent. In other instances the disease, without any evident 
cause, seems to be kindled up anew, and to go on with aggra- 
vated rather than lessened symptoms. We are bound also to 
add, that in the worst cases even the slight remission we have 
described as taking place about the middle of the disease, does 
not occur at all; but the fever progresses, from its commence- 
ment to its termination, without anything resembling a remis- 
sion or an interval. 

Listlessness and inattention, or disregard, even of present 
suffering, is characteristic of typhus. The patient will hardly 
mention his symptoms, unless in reply to a pointed enquiry. 
He will sometimes deny that he is sick, or mention only the 
slightest symptoms. I attended a Frenchman, who during for- 
ty days of continued fe^er, mentioned, but a single symptom — 



24 TYPHOID FEVER. 

he was tired. Ask if he had head ache, and he would reply 
that he had ; and although his abdomen was swollen and ten- 
der, he never seemed to think of it. A young robust negro 
who had this disease, denied altogether that he was sick ; and 
on being asked why he did not go to work, made no reply, but 
looked a little puzzled, and shook his head. 

After the first week, if the symptoms do not change for the 
better, they are apt to grow decidedly worse. The tongue, 
which in the beginning was white, becomes dark or brown, 
and sometimes almost black. It seems almost immovable in 
the bottom of the mouth, becomes dry and flattened on the top, 
and sharp at the edges like the tongue of a bird ; and has been 
denominated parrot longue. If the case terminates favorably, 
the dark scurf sloughs off, leaving the tongue tender and red. 
In a few instances the tongue differs altogether from this ap- 
pearance ; it is dry and of a fiery red colour, from first to last. 
The same cause which covers the tongue with fur; also cov- 
ers the teeth and the margin of the gums with a thick sordes, 
or encrustation, which adds to the offensiveness of the mouth. 

As the case approaches a termination, the skin becomes 
moist, and in many instances a copious perspiration takes 
place, during some portion of every day. A noisome smell is 
now obvious on coming near the bed. This peculiar smell is 
found in the breath from the first, and increases as the case 
grows worse. It admits of no description, is in a high degree 
loathsome, and points to the necessity of cleanliness and ven- 
tilation in the management of typhus. 

The delirium which is so common in this disease, " is pe- 
culiar." It seems to grow out of the listlessness, natural to 
the disease. The patient mutters at random, but can some- 
times be aroused to a decree of consciousness and understand- 
mg. He is seldom delirious many hours at a time, but is so 
most frequently at night, when there is a slight increase of 
fever. 

I may not dismiss the account of the symptoms of typhoid 
fever, without mentioning the eruptions which appear on the 
skin after it has reached its greatest height, often towards the 
close of the disease. The accurate observers of the present 
day, say that there are several kinds of these eruptions, and 
that they point out varieties in the disease. The questions 
which have been raised over them are yet undecided, and 1 
can add nothing to the stock of knowledge on this subject. I 
know not how man\^ names have been given to these eruptions. 
I believe the most common is petechia, from the resemblance 



TYPHOID FEVER. 25 

of the spots to fleabites. This shows how insignificant the 
eruption is in itself; but as a fact showing the tendency of this 
disease to throw out an eruption on the skin, it may be impor- 
tant. But of late, we see it stated, that there is an eruption 
distinct from petechia, and characteristic of typhoid fever. 

Having seen this eruption in but a single case, of which I 
preserved no memorandum, I referred to notes taken by my- 
self from Doctor Rush's lectures. He mentions in his man- 
ner of classifying diseases the petechial state of fever, but says 
he has never seen it, and takes the account from others. Now 
I have no doubt he had attended many patients who had this 
eruption, but his attention was not called to a few scattered 
spots, over the abdomen and thorax, which were of themselves 
too insignificant for notice. Since the fame of these spots has 
become so great, it has been my misfortune to have met with 
typhoid fever, only in colored persons, where their presence 
cannot be detected. I therefore take the liberty of copying 
from Watson the following account of them. The eruption 
sometimes occurs earlier, but commonly in the latter stage of 
the disease. " It consists ot small rosy blotches of a round- 
ish or lenticular shape, scarcely raised, if raised at all, above 
the general surface of the skin on which they appear. Ohom- 
el states that they vanish under pressure, but this is not so. I 
have again and again observed, that they diminish or become 
fainter under the pressure of the finger; but they are not effa- 
ced even for an instant. They are sometimes fewer, some- 
times so numerous as to dapple the whole surface of the abdo- 
men, or of the thorax, or of both. Upon the limbs they are 
less common and less closely set. I believe they often be- 
sprinkle the back, although they are seldom looked for there. 
They vary in intensity of color, and therefore, in distinctness. 
The whiter the skin the more obvious the spots become. In 
brunettes they may easily escape notice. In this form of dis- 
ease, the entire skin is often unnaturally dusk}-." This erup- 
tion Doctor Watson charges us to discriminate from petechia, 
which he sa}'s is sometimes intermingled with it. 

This rash, and others as trifling, which I shall not attempt to 
describe, are now regarded of some importance in detecting the 
nature and varieties of typhoid fever; but as they do not occur 
till towards the close of the disease, and have not, as far as I 
know, led to any suggestion for the improvement of its treat- 
ment, I shall pursue their investigation no further. 

I have mentioned diarrhoea as a symptom of typhus in its 
commencement. It often continues through its whole course, 



26 TYPHOID FEVER. 

and is evidently of fatal tendency. It is common in cases in 
which there is great tenderness of the abdomen, and probably 
ulceration of the intestines. 

Hemorrhage is frequent in this disease, and as far as I have 
noticed it, a very fatal symptom. A gush of blood from the 
nostril, which can be restrained with great difficulty, or copi- 
ous discharges of blood from the bowels, are the forms in 
which I have met with this symptom. There is seldom any 
delirium in these cases. 

I will add from Watson the following summary of symptoms, 
of which I have seen cases, which might have stood for ex- 
amples : 

"The delirium is peculiar. The patient wanders, at first, 
in the night only ; and the delirium commonly appears on his 
awaking from a disturbed sleep. Sometimes he is, desirous of 
getting up, and talks incessantly and earnestly in aloud voice, 
and can only be kept in bed by the imposition of some restraint. 
Usually, however, his rambling is of a tranquil kind, and with- 
out agitation. His mind seems elsewhere ; he is inattentive 
to all that passes around him ; but he lies still, muttering dis- 
jointed words or sentences, like a man talking in dreams. — 
From this state of typhomania the patient may sometimes be 
roused by loud speaking addressed to him, or by the sight of 
a strange face ; so that, though incoherent and delirious just 
before, he may become collected when his medical atten- 
dant enters the room. But he presently relapses. During 
the delirious state, there is a great deficiency of sensation, and 
insensibility to impressions. The patient is deaf. This deaf- 
ness you may hear spoken of as a good omen, or favorable 
sign ; but it is so only by comparison : it indicates a condition 
of brain less perilous than its opposite, in which the sense of 
hearing is morbidly acute. Imperfection or loss of vision is 
much rarer, and much more dangerous, than deafness ; yet 
the eye is generally dull — unlike the brilliant eye of acute 
phrenitis ; it corresponds with the expression of the counte- 
nance, which is perplexed rather than wild. Sometimes, how- 
ever, as the disease advances, black spots, like flies on the 
wing, musc(E vbliumtes, appear before the patient's eyes: in 
consequence, it is presumed, of partial insensibility of the re- 
tina. The patient attempts to grasp, or catch these in the air, 
or to pick them from the bed clothes. This is called jloccitatio. 
After these symptoms recovery is not common. The mouth 
and tongue are dry ; yet the patient no longer complains of 
thirst. The taste, the smell, the sense of touch, are all impair- 



TYPHOID FEVER. 27 

ed ; even external inflammation may take place, especially 
about the hips and sacrum, and go on to gangrene, without any 
complaint of pain from the patient. He seems altogether care- 
less about the issue of his disorder. If, at this period of the 
fever, you ask him how he does, he will probably declare that 
he is quite well. I have already alluded to the involuntary 
passage of the feces: this may depend, in part, especially in 
the advanced stage of the disorder, upon debility or paralysis 
of the sphincter muscles. The urine also dribbles away fre- 
quently : and these are points which must always be looked 
after, for the sake of keeping the patient as clean and dry as 
possible; the irritation of the urine and fecal matters tending to 
produce sloughing ulceration ; and secondly with the view of 
preventing the bladder from becoming unduly distended. Re- 
tention of urine and all its consequences may otherwise occur. 
It is a good general rule therefore to examine the hypogastric 
region every day with the hand ; and also to ask to see the 
urine, not for any purposes of prognosis, but to ascertain that 
it is regularly discharged." 

Bed sores are frequent in protracted cases of typhoid fever. 
They occur on the hips, or on the sacrum, and are commonly 
unnoticed, till they have become of considerable extent. They 
seldom happen unless the patient is delirious and lies too much 
on his back. This cannot always be hindered, as he will con- 
stantly resist being placed in any other position. In many ca- 
ses where the patient has passed many days on his back, in a 
state of great insensibility, his friends expecting every day to 
be his last ; the fever subsides, and he is found to have exten- 
sive bed sores, as they are called. They are in fact, real spots 
of mortification, and sometimes slough out to a great depth. I 
have seen such ulcers extend to the bone, and produce perma- 
nent injury of the back and paralysis of the legs. I have not 
often found these ulcers in fatal cases. On the contrary pa- 
tients who have them commonly recover. 

The closing scenes of typhoid fever need not detain us long. 
They vary in different cases, and as the termination is favora- 
ble or otherwise. In acute cases, which terminate in a week 
or ten days, the symptoms are proportionally rapid and vio- 
lent. The pulse is rapid from the first, and becomes irregular 
and trembling ; the breathing is hurried and the breath noi- 
some and offensive ; there is delirium but no twitch frigs of the 
tendons ; diarrhoea but no eruption on the skin ; and as the 
case approaches a termination, a copious perspiration spreads 
all over the body. When the case is protracted to the third 



28 TYPHOID FEVER. 

week, or longer, the symptoms are different. The patient lies 
on his back, slips down towards the foot of the bed ; is coma- 
tose, and breathes more and more heavily, till death closes the 
scene. 

When the termination of the case is favorable, there is no 
visible crisis which can be pointed to, as the cause, or in any 
decree connected with it. If there are copious discharges by 
the bowels, or in perspiration from the skin, these symptoms 
are unfavorable. Hemorrhage is still more so. And the most 
favorable symptom is a change for the better, however gradual. 

While there is life there is hope, is a maxim applicable to ty- 
phoid fever. Some recover, from situations apparently the 
most hopeless. I attended a young man who lay apparently 
at the point of death in this disease for many weeks ; he was 
comatose, and resembled the dead more than the living ; yet 
he did not die. His recovery was but partial ; he was so de- 
bilitated, and paralysed, that he moved with great difficulty, 
on crutches for the balance of his life. Another rising from 
like circumstances, was deprived of the power of speech, and 
never fully recovered. 

One more example, and w T e have done with the death scenes 
of typhoid fever. Postmortem examinations have shewn that 
many fatal cases of typhus, are attended with extensive pus- 
tules, and resulting ulcers in the small intestines. These ulcers 
in the intestines, are said to be most extensive, where there is 
no eruption on the skin. When the eruption appears, it is apt 
to be late in the disease, and the ulceration of the bowels hap- 
pens about the same time. This ulceration sometimes pene- 
trates the bowels, and allows their contents to escape into the 
cavity of the abdomen, producing death in a day or two. The 
fever which results in this accident, is not always of a very vio- 
lent grade. I recently attended an interesting young man, who 
had fever with tenderness of the abdomen, for about two weeks. 
His symptoms were not violent, and he was hardly confined to 
his room for more than three or four days, and for two or three 
days towards the last, he seemed to be recovering, in the usual, 
gradual way. He was seized suddenly, with violent pain in 
the bowels, and his abdomen became immediately swollen and 
tense. His countenance became ghastly, and his pulse feeble, 
rapid, and tremulous. He died in thirty-six hours. Such 
are the symptoms and termination of typhoid fever w T hen it 
produces perforations in the intestines. 



TYPHOID FEVER. 



OF THE VARIETIES OF TYPHOID FEVER. 

When Doctor Cullen divided fever into several species, 
according to the force of the circulation or strength of the 
pulse, he laid the foundation of a confusion in the discussion 
of the subject, which succeeding authors have not gotten rid 
of. According to his system, two persons exposed to the 
same contagion will contract fever ; one perhaps, a synochus, 
and one a typhus. Now if Doctor Cullen meant no distinct 
kind of disease, by these names, but only grades of the same 
disease, his followers have not adhered to his maxims. For 
T believe it is generally conceded, that his synochus is an in- 
flammatory fever from whatever cause, and his typhus, a fe- 
ver with great prostration, however it may have originated. — 
Hence a synochus fever might usher in a pleurisy, and a ty- 
phus terminate an attack of bilious fever. All this might 
have been gotten along with, if these terms had been kept 
strictly to their meanings ; but typhoid fever under some 
name, was unavoidably considered a separate disease, and en- 
titled to a name whether the pulse was high or low. Many 
are the disputes I have heard amongst medical men, one as- 
serting that there was no original typhus fever, at least in this 
country, and the other asserting that such fevers were of dai- 
ly occurrence. 

Doctor Rush, must I apprehend, bear a part of the respon- 
sibility, of the confused notions of typhus, which still to some 
extent prevail. 1 copy the following from my notes on his lec- 
tures : 

"Jn the typhoid state of fever, remedies of both classes 
(stimulants and sedatives) are occasionally proper. This state 
of fever occurs in almost all fevers, during some part of their 
course ; but it is sometimes an original affection, and plainly 
marked in its commencement. In this disease, the pulse is 
round, soft, and quick ; the skin dry, and the tongue moist — 
This state of fever has been happily termed the slow chronic 
fever ; it often runs into typhus, and is then termed the low 
chronic fever." These names are of no use, and are happily 
obsolete or forgotten. 

Now I have felt unable to do better, than to call by the name 
typhoid f eve?-, the great disease of human nature, of all nations 
and of all ages. This disease must bear its name, w r hetber 
the pulse is weak or stiong, rapid or slow. It is of a kind, as 
we have endeavored to show, distinct from every other, and 



30 TYPHOID FEVER. 

it is now our purpose to investigate the varieties under which 
it has been seen. 

I concur with Doctor Watson in the opinion, that for the 
continued fevers which have been described under different 
names by various authors, there is probably but one cause; 
and that, whatever cause we may assign for them, "There is 
no line of genuine distinction between continued fevers, that 
can be relied on. They run insensibly into each other, even 
the most dissimilar of them, and are traceable often to the 
same contagion." But the disease presents itself under vari- 
ous forms, and I quote again from the same authority. 

"Although fever is, as I have stated, a specific disease, it 
assumes divers forms ; and so dissimilar are some of its pha- 
ses, that they might seem to belong to totally different mala- 
dies. These variations relate not only to individual cases, but 
to w T hole epidemics. In some places and seasons, the inflam- 
matory type predominates, marked by excitement of the san- 
guiferous system; in others, depression of the nervous system, 
characteristic of the typhoid type, is the prominent feature of 
the disease. Most general!} 7 of all, the disorder commences 
with inflammatory fever, and ends with typhoid symptoms." 

As I progress with this subject, I feel that it is becoming 
more complicated, and bearing wider from the simple truths 
of nature. I quote still farther from Doctor Watson. " The 
most usual variety of continued fever, is represented by the 
synochus" of Doctor Cullen, "which is a compound of the two 
others" — the inflammatory and typhus. 

The differences observed in typhoid fever in different cases, 
and in different seasons, seem to manifest themselves in the 
force of the disease. In some the fever is violent and the 
pulse strong and full ; but in others, the pulse gives way, and 
prostration, with the universal!} 7 acknowledged symptoms of 
typhoid fever, prevails from the first. And these differences 
after all, Doctor Watson concludes, depend more upon an ac- 
quired disposition of the human body, than upon any essential 
change in the nature of the disease, or the virus which occa- 
sions it. 

I have thought myself obliged to say this much, of the va- 
rieties alleged to exist in typhoid fever. They are not incon- 
sistent with the belief that the disease is, in all its varieties, pro- 
duced by the same cause. They are for the most part, easily 
discriminated, and valuable as guides in practice; but they are 
by no means, so striking. or important, as the varieties or differ- 



TYPHOID FEVER. 31 

ences, which present themselves in different cases of bilious 
fever. 

When a case of fever presents itself in a temperate or south- 
ern climate, the great question is, whether it is of the bilious or 
malarious type, or whether it is typhoid. The unexperienced 
ought to read the description of these two kinds of fever, before 
he decides this question. He need not read the whole essay 
on each kind, but the account of the symptoms only. He will 
not find them lengthy, and I think, that if he reads with care 
and attention, he will hardly mistake one of these diseases for 
the other. And this point I urge the more, as I have nowhere 
seen the differences of these diseases clearly pointed out, and 
believe it is a common opinion, that a bilious lever frequently 
11 runs into typhus" 

This opinion is as pernicious as it is erroneous ; for it leads 
to the use of remedies wholly improper. The protracted ca- 
ses of bilious fever are controlled and arrested by remedies, 
which would be pernicious or fatal in t} T phoid fever. 

TREATMENT OF TYPHOID FEVER. 

In a disease so important, so widely diffused, and univer- 
sally known, as typhoid fever ; it is painful to be obliged to 
say, that there is no established mode of treatment. Remedies 
the most opposite in their nature, and effects, are recommend- 
ed with equal confidence, and I may say, with equal authority. 
I have therefore, no fear of offering a single remedy, for which 
I could not easily find authority, in the writings of authors of 
established reputation. But I have satisfied myself that there 
is a preference due to a certain mode of treatment, and I shall 
recommend it, without claiming for it, any originality or ex- 
traordinary efficacy. 

It has been said, that this disease has a definite course to 
run, and that thus far, no remedy has been found which will 
shorten its duration. It is also said, that there is hardly any 
difference in the success of different modes of practice ; and 
it is certain, that remedies have less influence on typhoid fever, 
than on several other diseases. These facts are so striking, 
that the}^ have been the foundation of more scepticism, in re- 
gard to the efficacy of medicine, than perhaps any other. — 
These suggestions, warn us against expecting too much from 
remedies in typhus ; we are not warranted in expecting the 
disease to disappear so soon as we have administered our 
remedy ; but should be satisfied, if our patient is placed in a 



32 TYPHOID FEVER. 

state of greater comfort, and more safety. It is agreed, that 
the changes which happen in the progress of fever, are not of- 
ten to be foreseen or accounted for; and that while we ought 
to be modest in claiming every favorable change as the effect 
of remedies ; we should be equally fortified against charging 
to the ill effect of remedies, the unfavorable changes which 
happen under their use. We are never to forget that typhoid 
fever is a disease of such obstinacy, that it will often keep its 
own course, in spite of all our efforts. 

It is on all hands agreed, that we have not discovered any 
specific remedy for typhoid fever, or, as older writers would have 
expressed it — u any antidote to the poison of this disease." — 
Since the days of Brown, our remedies have been divided into 
stimulants and sedatives, or those which give force and activi- 
ty to the powers of life, more particularly to the circulation of 
the blood, and those which reduce or weaken these powers. — 
Stimulants are used to support the sinking powers of life, and 
to arouse from the prostration and torpor of the lowest states 
of typhus ; sedatives are demanded to lessen those poweis 
which may be acting in excess, even in typhus ; for example, 
to lessen the force and frequency of the pulse, or to reduce the 
excess of heat which sometimes prevails. But we should be on 
our guard against doing too much ; for nature has a part to act, 
in which we may do harm by thwarting her purposes. In refer- 
ence to these views, Doctor Rush, in his lectures said, " That 
the whole business of the physician, is to abstract, add, and do 
nothing at all" To abstract when the diseased action is too 
high, by bloodletting and other sedative remedies ; to add, by 
stimulants, when the action is too low ; and to do nothing, when 
the powers of nature seemed of themselves sufficient. He en- 
forced with great eloquence, the maxim, that any one may know 
when to give a remedy, but it takes a physician to know when to 
withhold it. 

Typhoid fever is caused by a poison in the blood, or in some 
other way present in the system. If the patient can live a giv- 
en time, and no fatal injury happen to any vital organ, the poi- 
son will have passed off and he will recover. Bearing this in 
mind, our remedies have a proper object in lessening the force 
of the disease in the most active stage, and sustaining the natu- 
ral powers of the patient at all times, and especially in the latter 
stage of the complaint. This plan of treatment is as consistent 
with reason as it is approved by experience ; and the measures 
we shall recommend are such as we have found best qualified 
to carry it out. 



TYPHOID FEVFR. 33 

REMEDIES. 

Do not be in too much haste to give your remedy, in continu- 
ed fever. First be sure the case is not bilious fever — next, 
that it is not measles, small pox, or scarlet fever. There will 
be no mistake after the first four or five days, as the eruptive 
state of these diseases will have arrived ; but this develope- 
ment cannot well be waited for. 

Having made up your opinion as to the nature of the case, 
you will select your remedy according to the present symp- 
toms, and stage of the disease. If the pulse is full, frequent, 
and strong, the face flushed, and eyes reddened and watery : 
if the pain in the head or limbs is great, and the attack has 
been of but few days' duration, you have the rare case of in- 
flammatory typhoid fever. For these symptoms, every Eng- 
lish writer will tell you to draw blood from the arm, make ap- 
plication of cold water by napkins to the head, and give a car- 
thartic of calomel with castor oil or rhubard. Now I am not 
prepared to say that these symptoms never occur in typhoid 
fever, but they are so rare, that I have never met them. I do 
not deny that the remedies mentioned are suited to the case ; 
but I warn the practitioner, to be on his guard, and not to over- 
look the symptoms of prostration which are prominent in every 
case of typhoid fever. Do not let a little roundness, or full- 
ness of the pulse, pass for the thrilling beat produced by in- 
flammation. Do not let a flushed face and burning skin de- 
ceive you. and hurry you into prescriptions too powerful for 
the strength of your patient. I give you the opinion that in 
typhoid fever, however imposing the symptoms may be ; how- 
ever they may entitle the disease to rank with inflammatory 
affections, the patient will be found unable to bear the abstrac- 
tion of much blood ; he will sink, and give way under active 
depletion. 

Bloodletting and cathartics have been the anchors of British 
practice, since the days of Sydenham. In France the oppo- 
site course, of using almost no remedies prevailed, and at last 
under the fanciful theories of Broussais, became a system. — 
The partisans of each system became heated, and while the 
English physicians were charged with killing their patients, 
the French were charged with letting theirs die. Both parties 
seem at last, sensible that they have pushed their arguments 
too far. A spirit of liberality seems to have arisen and each 
seems willing to allow that the other has been less in error, 
than might have been supposed. It is thought that in France, 
3 



34 TYPHOID FEVER. 

typhoid fever is a disease of greater prostration than it is in 
England, and that the bloodletting, which is proper in England 
is not proper in France. From my own observation in this 
country, I am compelled to join the French party ; so far at 
least, as to forbid the bloodletting and other active treatment 
urged on us by the highest English authority. 

But there is hope, that this great point in practice is about to 
be settled. English writers inform us, that the disease has of 
late undergone a change in that country. That now it is rare- 
ly, if ever, an inflammatory lever, and that there is now, scarce- 
ly any use for the lancet in typhoid fever. I am free to con- 
fess, that I think the opinions of the English physicians, have 
changed, more than the diseases of their climate. Certain it 
is, that having followed the precepts of Doctor Rush, till I be- 
came convinced they were wrong in typhus ; I have for many 
years regarded the practice founded on them, as full of danger. 
For a long time, I considered myself as standing alone, on 
these opinions in this country, but it is with great satisfaction, 
1 am now able to say, that the remedies I shall recommend 
have the sanction of high authority on both sides of the Atlan- 
tic. The reader will recollect, that I condemn, general blood- 
letting and active cathartics in typhoid fever, and now we are 
prepared to offer the remedies, I think most useful in this dis- 
ease. 

The first remedy I shall reccommend is an emetic. This 
may be of tartar emetic, or ipecacuanha. This remedy is 
called for, when there is great sickness at the stomach, with 
heat and fever. It is chiefly applicable to the first week of 
the disease. It is not forbidden by paleness or considerable 
quickness of the pulse, for these symptoms may depend on 
nausea. The emetic should be prompt; twenty grains of epe- 
cac in a spoonful of cold water, followed in ten minutes by 
half a pint of cold water if the patient can take it. If the cold 
water is objected to, a cup of weak tea may be substituted. — 
The object of giving the emetic in this manner, is to procure 
the free evacuation of the contents of the stomach at once, and 
to hinder or lessen the action of the remedy on the bowels as a 
cathartic. 

The tartar emetic is to be preferred where the patient is ro- 
bust, and the fever high and of recent occurrence. Two grains 
may be given in a small quantity of water, and here it is 
important to give half a pint of water, cold or tepid, ten minutes 
after the dose is taken. If in fifteen minutes more it does not 
prove emetic, give half a pint more of tepid water, and let the 



TYPHOID FEVER. 35 

patient try if necessary to bring on vomiting by running his 
ringer down his throat. No more tartar emetic is to be given. 
This manner of giving the emetic, is advised, that it may act 
promptly and fully, and that the tartar emetic may not pass 
into the bowels and act as a cathartic. 

When the emetic has operated two or three times, and the 
contents of the stomach seem to be freely discharged, give a 
dose of laudanum. Twenty drops will be sufficient, if the pa- 
tient does not seem to be much exhausted, but the dose may be 
increased to sixty drops, if the symptoms of prostration are ve- 
ry striking. This use of laudanum, may be made after the use 
of epecac as an emetic, but it is not so often necessar} r , and 
should not be given within an hour of the epecac, for from 
some unknown cause, ipecac is not controlled in its operatiou 
by laudanum, but will go on operating as if no laudanum had 
been given. If the laudanum is thrown up, a second, but 
somewhat smaller dose may be given. I have thus early in- 
troduced laudanum or opium into my account of the remedies 
for typhoid fever, I shall say more of it hereafter. 

Such is in my opinion the best manner of administering 
emetics in typhoid fever. They are not very often required, 
for the symptoms we have mentioned as requiring them, are 
not often present. Yet I have sometimes met with several ca- 
ses in the same family, all affected with great disorder of the 
stomach, and I have found emetics very useful in them. The 
emetic will seldom require to be repeated, and I should hesi- 
tate in giving it more than once, or twice in the first week, and 
hardly ever after that time. 

The next remedy I shall mention, is cathartics. These are 
to be given with full as much caution, as emetics. In a great 
majority of cases they are wholly uncalled for and improper. — 
Diarrhoea is a common symptom of typhus, from the first, and 
it has never appeared to me that this diarrhoea has yielded to 
cathartic medicines. On the contrary, I have seen costive- 
ness removed by a light cathartic, to be followed by the most 
troublesome diarrhoea. The cases in which I use cathartics, 
are those in which the stomach is disordered with frequent 
vomiting or heaving. Five grains of calomel followed bv a ta- 
ble spoonful of castor oil, in three or four hours, will often re- 
lieve such symptoms. Such a dose may be given in the first 
stage of the disease, and before the strength of the patient has 
failed him too much, but in the latter stage, costiveness is only 
to be removed by administering injections of a very mild kind, 
such as soap-suds or gruel. 



36 TYPHOID FEVER. 

Costiveness is not always an evil in typhoid fever. The 
disease in its chronic form, the slow fever, of common lan- 
guage, is one of universal torpor. Mind, body, limbs, and in- 
testines, are torpid. The patient will lie on his back for days, 
and never rise to evacuate the bowels or discharge urine un- 
less he is urged. I early learned to dread cathartics ; and bad 
nurses and poverty-stricken patients, taught me, not to fear 
costiveness. I have attended many who could not procure 
the administration of an injection, and have seen them lie 
from one to three weeks without a discharge from the bowels. 
Such persons in almost every instance recovered, and it was 
so long, that I had never seen a patient, who was costive in 
typhus fever, fail to recover, that I came to the conclusion, that 
there was no danger while the bowels were fast. And even 
now, I can say, that the best symptom which can be found in 
typhus, is a constipated state of the bowels. 

No remedy has had a more ample and fair trial, than ca- 
thartics in typhoid fever. They have been " weighed in the 
balance and found wanting." No one believes, that they car- 
ry oifor destroy the disease, in a single instance. Every one 
acknowledges the harm they do when the intestines are in- 
flamed or ulcerated, as they so often are in typhus. The rule 
is to use and not abuse this potent remedy, and my opinion is, 
that even the small use I make of them, is probably more than 
will he found necessary. 

Calomel and other preparations of mecury are of almost 
universal use in this country. I cannot dismiss the remedies 
for typhus, without adverting to them. I have tried, and seen 
them used extensively, first as a cathartic, and next to induce 
salivation. I have never seen typhoid fever yield to saliva- 
tion. I have seen the salivation appear in the midst of the fe- 
ver, and give way before the fever had subsided. I have not 
often witnessed this, but I do not desire to repeat the experi- 
ment. As a cathartic, calomel answers as well as other reme- 
dies, and no better. I do not think, that calomel, blue pill, 
mercurial ointment, or any other preparation of mercury, for 
external or internal use, has any particular beneficial effect 
in typhoid fever. On the contrary, I have thought that per- 
sons who had been salivated, or had taken mercury in broken 
doses during their treatment, have had remarkably slow and 
imperfect recoveries from this malady. 

Our next remedy is the application of cold by means of air 
and water. This is, in my opinion, the most available, useful, 
and valuable remedy we have in typhoid or continued fever. — - 



TYPHOID FEVER. 37 

It puts it in our power at any time, to reduce the heat to any 
desirable standard, and to lessen the force of the circulation at 
will. Here then are two points in the disease, under our con- 
trol, and if they are managed with skill, I think the greatest 
benefit can be obtained. Yet with this power over the heat, 
and over the pulse, our means of arresting typhoid fever, are 
very limited. I think we in many instances, lessen its vio- 
lence, and avert the danger, but the disease will run its course. 

Doctor Currie of Liverpool, obtained great renown for his 
experiments in the use of cold water in the treatment of fever. 
I think these experiments were rude and unsatisfactory, and his 
maxims drawn from them, unsound and of little practical utili- 
ty. Like others who have sought distinction by heralding a 
particular remedy, he has put the human constitution to the 
test of what it can bear, from cold water. His pouring over 
the patient, four or five gallons of water, reduced to forty -five 
degrees ; twenty degrees below the well water of Milledge- 
ville, was a remedy harsh and cruel in the extreme. It is not 
wonderful that some of his followers found it impossible to get 
their patients to submit to it. He has the merit of having in- 
duced practitioners, to make a bold and fearless use of cold 
water. Experience has remedied some of the defects of his 
system, but I have no where seen a plan laid down which I 
could fully approve. I advise the following plan. 

Typhoid fever usually has a daily exacerbation ; a sensible 
rise at some period oi' each day. This rise is most common 
in the forenoon, and the fever from that time, continues at its 
height, through the rest of the day and night, and produces 
delirium or coma at night if at all. It is in this state of ex- 
citement, that cold applications should be made. 

The physician should if practicable, make the first applica- 
tion of the remedy with his own hands. If he cannot be pres- 
ent at the proper time, another may do it. Take two or three 
quarts of cold water in a bowl, and commence by dipping a 
towel into it, and bathing the head and face, then extend it to 
the hands and arms, feet, and legs. This is enough surface 
to apply the remedy to, and in typhoid fever, it scarcely 
ever fails to be as powerful in the reduction of the pulse, and 
of the heat, as could be desired. It will seldom require more 
than half an hour, to reduce the pulse as much as it is prudent 
to do at any one time. If it is desired to hasten the process, 
put a fan in the hand of an assistant, and let a brisk current of 
air be applied to all the wet surface as long as necessary. — 
This adds greatly to the power of the remedy. The power of 



38 TYPHOID FEVER. 

this remedy is in proportion to the extent of the surface, the 
coldness of the water, and the rapidity of the evaporation. 

I have said that the physician should be present, and this is 
important for two reasons. The first is, that an inexperienced 
nurse, will wring the towels, and barely moisten the surface, 
and thus render the remedy nugatory; whereas the water 
should be freely applied, and if the bed is partially wet, it can 
do no harm. The next and most important reason is, that the 
remedy may be stopped at a proper time. The physician 
should examine the pulse, and when it is reduced considerably, 
stop the bathing ; and allow the water slowly to evaporate.— 
It should not be wiped from the surface ; and if there is 
wet clothing, or bed clothes, about the patient, let these dry 
from the heat of his body. Nothing can be more improper, 
than the common plan of withdrawing the cold suddenly, and 
covering the patient with warm clothing. If the fever rises 
soon after the bathing is over, it should be repeated as often as 
it may appear necessary. This whole process is extremely 
easy, cleanly, and comfortable. Few are so torpid, as not to 
acknowledge the comfort and relief it affords. 

We are charged not to apply cold, when the patient rejects 
it, and when it raises on the skin, what is termed goose-flesh. 
I believe this difficulty almost alwa} T s arises from inattention to 
the daily rise of the fever, which I have mentioned. During 
a few hours before this rise, the patient will shrink from the ap- 
plication, and it ought not to be made. But the same patient 
will, in a few hours, receive the application with joy. 

The sudden manner, in which the pulse in typhoid fever, 
will give way, under the application of cold water, has always 
been a matter of surprise to me. In inflammation of the brain, 
with intense pain, and full bounding pulse, I have directed the 
application of ice in bladders, to the head, for days together, 
When symptoms very similar, occur in t} r phus, the pulse in- 
variably gives way in a short time, from the application of 
cold water, and I have no doubt but the application of ice for 
many hours would be fatal. 

There are cases in which, from the habit of bathing with 
warm water alone, the application of cold water will be strong- 
ly objected to. I attended a lady in a spell of sickness, which 
she attributed to bathing her feet in cold water, which she had 
not done in many years. Such persons may be gratified with 
the substitution of water raised to a comfortable heat. Let 
the water be applied in this state, and evaporated on the skin 
by fanning, and its effect will be found sufficient. 



TYPHOID FEVER. 39 

Doctor Currie, I think, objects to the use of cold bathing, 
when patients are covered with perspiration. To this rule 
there are many exceptions. Perspiration seems to be the natu- 
ral crisis of typhus, and when it happens in the latter part of 
the night, and is moderate, with improving symptoms, let no 
cold water be applied. But there are many, of the most dan- 
gerous cases of typhus, attended with wasting sweats almost 
trom the first. These cases are commonly attended with de- 
lirium or coma, and on approaching the bed, a sickening steam 
seems to meet you. The parts of the body exposed to the 
air, may feel cool, but place your hand under the clothing, or 
between the patient and the bed, and you find a high degree of 
heat. If these symptoms occur early in the disease, though the 
patient sweat as rain, lose no time in applying the cold water. 
If ever I saw patients rescued from the grave in t} 7 phus, it has 
been in such cases as these, from the free application of cold 
water. I have seen the mind cleared of the clouds of delirium 
in hUlf an hour, and the symptoms thenceforth take a more fa- 
vorable turn. 

Cold bathing, or, as the manner in which I use it is more 
properly termed, cold affusion, is useful in high and dangerous 
cases of fever ; it can be used more or less frequently, or more 
or less extensively, as each case may lequire, and is a valuable 
remedy when prudently administered. But where the case is 
moderate with scarcely any obvious daily rise of fever — when 
it bears on with even tenor, scarcely altering from day to day, 
according to the real slow fever rule, I have not advised the ap- 
plication of cold, and should not expect any benefit from it. 

There is yet another class of cases, in which cold bathing 
cannot be beneficially used. This is the highest and most 
malignant class, in which the powers of the system seem to 
give way without a struggle, and the patient sinks to death 
without having passed through the violence of disease which 
might seem to account for it. These cases seem to pass over 
the first, to the last stage of the disease at once ; they remind 
us of an over close of poison, and I cannot help thinking they 
are literally so. The poison is too great for resistance, and 
the bemnninsf and the end are almost the same. These ca- 
ses have been termed, congestive, malignant, and I know- 
not what else. They are known by a sudden prostration of 
strength, and rapid, flying pulse. In some cases, coma begins 
and ends them. They are peculiarly embarrassing, and diffi- 
cult to judge of; and not a few of them change suddenly for 
the better, and terminate favorably, without loss of time. — 



40 TYPHOID FEVEE. 

These cases unquestionably forbid the use of all depressing- 
agents. 

Doctor Watson advises the hair to be cut close, or shaven, 
in typhus, and napkins dipped in cold water, kept constantly 
to the head. He advises water from forty to fifty degrees, to 
be used in this way. This would be a good prescription for 
acute inflammation of the brain. It is a remedy of great pow- 
er, and if it is so applied in typhoid fever, it should be con- 
stantly attended to, and removed as soon as the pulse and heat 
are somewhat reduced. Let it never be forgotten, that this 
fever is never to be pursued too far, with remedies which les- 
sen the powers of life. 

Opium is a much questioned remedy, in continued fever. — 
Every body knows the attempt of Doctor Brown, to substitute 
it, as a general remedy for fevers of this kind, in opposition to the 
then established practice of bloodletting, emetics, and cathar- 
tics. It is equally well known, that with great passion and 
violence, he, with his remed}^, was put down, and repudiated ; 
so that now, after the lapse of half a century, opium can hard- 
ly have a fair hearing before the medical profession. I believe 
that Doctor Brown was more than half right, in this great 
controversy. — Opium is a great remedy in typhus. It is use- 
ful in all the forms and varieties of this disease. How should 
it be otherwise ? Typhoid fever, prostrates the powers of 
life, deranges the nervous energy, produces local irritation 
in a hundred ways, and sometimes deprives the sufferer of 
sleep and rest. For all these evils, what remedy is equal 
to opium? But it does not remove the cause of these evils 
in typhus, and they return again after the effect of the reme- 
dy is past. True ; and alas that it is ! But what remedy is 
free from this objection ; have we a specific for this disease ? 
No one pretends that we have. 

In the highest, most congestive, and dangerous forms of tyr 
phus, opium is our sheet anchor. If the patient is struck down 
with coma, or has delirium with rapid pulse, and tossing from 
side to side; and if these symptoms occur on the first, or second, 
or third or fourth, or any other day of the disease, give opium. 
Give two grains of solid opium, every six hours. Or give six- 
ty drops of laudanum as often, or a third of a grain of mor- 
phine a little oftener ; or in the event that your patient is too 
comatose to swallow remedies, give two tea spoonfuls of lauda- 
num by way of injection. Give this remedy a fair trial. Try 
a second dose. Perhaps your patient may fall into a profound 
sleep, or run out of coma into a sleep, for life and not for death. 



TYPHOID FEVER. 41 

If he sleeps, let him rest, and hope that he will awake with bet- 
ter symptoms. If this will not relieve him, I think nothing 
else will do it. He must take his fate. I know that many 
other remedies are showered down on patients in these un- 
fortuate circumstances. They are bled, leeched, cupped, and 
fomented — they are bathed with cold water on the head, and 
warm water on the feet ; tormented with blisters, pepper, 
and mustard, and I know not what else ; but I would not give 
a single dose of opium for a thousand such remedies. 

In milder cases of this disease, opium still has its place. — 
Where there is a rise of fever, with restlessness at night, give 
ten grains of Dover's powder at nine o'clock or later. If it is 
given too soon, the quiet it is calculated to produce, may not 
follow its administration. It should be given when the fe- 
ver is declining. The dose may be enlarged, even doubled, 
in cases of great restlessness. If the fever runs an even course, 
without much rise at night, give a smaller dose, say eight grains 
twice a day, morning and evening. This remedy allays irri- 
tation, gives quiet and comfortable nights, and may be given 
during the whole course of the disease. Where the bowels are 
disordered, laudanum or solid opium should be given instead 
of the Dover's powder. Twenty to thirty drops of laudanum, 
or a grain, or a grain and a half of opium, will be a proper dose. 
For many days, during the first stage of typhoid fever, I fre- 
quently administer no other remedy but some preparation of 
opium. But if the disease is of a higher grade, with more fe- 
ver and local disease ; other remedies may be added or substi- 
tuted. 

When the fever is high, pulse full and strong, and the pa- 
tient's strength not yet exhausted, though the pain and restless- 
ness may be great, there is doubt of the propriety of giving 
opium. Remedies to reduce the pulse should first be used, 
such as cold applications, and sometimes emetics. The ques- 
tion of giving opium is often doubtful and embarrassing. 
Writers say it may heighten all the symptoms of fever, and 
render coma fatal. This is the view of those who see inflam- 
mation in every heated body. M}~ own opinion is that the er- 
ror has been, in withholding the opium. The excitement of 
typhus differs from inflammation. It gives way to the slight- 
est depleting remedy, and especially is it allayed, quieted, and 
subdued by opium. A late writer who had often witnessed 
the inefricacy of leeches, cups, and saline mixtures, in allay- 
ing the heat, pain, and restlessness in these cases, says, give 
laudanum in small and repeated doses, so as to allay the pain 



42 TYPHOID FEVER. 

without exciting the fever. Try the remedy, but do it with 
great caution. This is a very bad mode of giving opium in 
doubtful cases. If it will do good, it is only by giving a suffi- 
cient dose at once. The excitement of the first hour may be 
dreaded, but after that the operation is favorable. I do not re- 
peat the remedy, in less than six hours, and commonly not then. 
If the dose has been sufficient, its effect will continue for 
twelve hours or longer. It is the anodyne effect we desire, in 
these cases. 

And now I am to make my last appeal in favor of opium in 
typhoid fever. I come to the great argument in every contest 
of this kind, my own experience. I have, for thirty years, giv- 
en opium, as I have advised it in this essay. I think my prac- 
tice has been more successful, than a different course would 
have been. The immediate effect of the remedy is most sooth- 
ing and comforting to the sufferer ; its ultimate ill effect I con- 
fess I have not seen. True, it does not always relieve delirium 
or coma, it does, not always still the agitation of the system. 
But it is also true, that in a great many cases, it affords the 
most obvious relief. It removes the wakefulness, restlessness, 
and muscular pains, so troublesome at night in slight cases, 
like a charm. It often allays the graver symptoms of delirium 
and throbbing pulse, and I have seen it successful in removing 
the deepest coma, in the first stage of the complaint. The er- 
ror has been in withholding opium in these cases. 

Sudorifics and diuretics, or medicines producing perspira- 
tion, or operating on the kidneys to produce an increased flow 
of urine, nave long been regarded as remedies in fever. They 
are of less value than has been thought, and have been of late, 
a good deal neglected. I shall mention a few of them, with 
the remark that the same article commonly operates to increase 
both these discharges, and that I think they are sometimes use- 
ful in typhus. 

_ Sweet Spirit of Nitre — the Spiritus Aetheris Nitrici of the 
dispensatory, is probably the best of these remedies. It may 
be given, even where the face is flushed, and the skin dry and 
hot, but is still more useful where there is a pale countenance, 
dry skin, and moderate fever, withdry mouth, and a small dis- 
charge of urine. A teaspoon full is a full dose, and it may be 
repeated once in two hours. It may be expected to produce a 
moderate perspiration, and a moderate flow of limpid urine. 
More than this oaght not to be required of it in typhus, and 
when these effects are observed, it should be suspended. 
Larger doses of this remedy may be safely taken, and more 



TYPHOID FEVER. 43 

decided effects produced, but such use of it is not proper in 
this disease. The remedy may be repeated, from time to time, 
according to the discretion of the physician, throughout the dis- 
ease. It should not be kept a great while before it is used, as 
it deteriorates with time. Acetate of Ammonioe, is also a 
remedy which may be given in the highest state of typhoid 
fever, to promote perspiration, and also to increase the flow 
of urine. A table spoonful of the solution may be given once 
in two or three hours, for a day or more at a time. It is a mild 
remedy, comfortable to the stomach, and has maintained its 
ground along time in the treatment of this disease. 

Nitrate of Potash, or Saltpetre, deserves a place here. This 
salt is a sedative medicine, and proper in typhus, when the fe- 
ver is high, and the pulse rapid or strong. It may be given in 
doses of from five to ten grains every two or three hours. 
This is a valuable remedy, reducing heat, promoting perspira- 
tion, and passing off freely by urine; but can seldom be long 
continued in typhus, as it is apt to operate on the bowels, when 
all its good effects seem to cease — and the debility which it 
produces is hurtful. 

Tartar emetic is not to be omitted, while discussing these 
remedies. Its power to repress fever, and promote the secre- 
tion of urine and perspiration, are decided. It is less useful 
in typhus, than in malarious and inflammatory fevers ; because 
of its tendency to operate as a wasting, water discharging ca- 
thartic. When it produces these effects, its use in typhoid 
fever must be suspended. We have before stated the manner 
in which it may be given as an emetic, in high grades of this 
disease. But it may be given in broken doses, one eighth of a 
grain every two hours, to lessen fever, and allay irritation and 
pain. The doses may be increased or lessened as its effect is 
more or less obvious, and if it begins to operate as a cathartic, 
stop the use of it, and give twenty or thirty drops of laudanum. 

Tartar emetic may be given alone, or together with either of 
the remedies we have just mentioned as sudorifics or diuretics. 
In these combinations it is to be recollected, that the tartar 
emetic is the active ingredient, and its effects are to be first "re- 
garded. It should also be borne in mind, that these combina- 
tions are only proper in the highest degrees of fever, and to be 
discontinued as soon as the action is reduced. A few hours 
will commonly be long enough to continue these remedies at 
one time. When the combined use of these remedies is re- 
solved on, the tartar emetic may be given separate, or com- 
bined. If the Spirit of Nitre, or Acetate of Ammonia? is given, 



44 TYPHOID FEVER. 

give the tartar emetic separately, in doses of one eighth of a 
grain, once in an hour or two, according to circumstances. 
With the Nitre or saltpetre, it is conveniently combined in the 
antimonial solution. Take two drachms of nitre and two 
grains of tartar emetic, and dissolve them together in half a 
pint of water. A table spoonful may be given once in two 
hours. This is very active treatment in typhus, seldom called 
for, and never to be long continued. 

If the occasional use of stimulants and anodynes in the first 
stage of typhus has been questioned, there is a closing stage in 
which there is no dispute over the question. All agree that in 
the last stage of typhus, stimulants and tonics are the proper 
remedies. The great question is, when to commence with 
them; and I give it as my opinion, that you will hardly do it 
too early. Try the stimulants, and anodynes, and watch their 
effects closely. If they increase the fever and quicken the 
pulse, suspend them ; if they quiet the patient, and render the 
pulse slow and round, they are proper and to be continued. 
These observations may be made two or three hours after the 
remedy is given. 

The first of these stimulants which I shall mention is the 
favorite prescription of professor Barton ; the hot infusion of 
bark and snakeroot. Take of Peruvian Bark two ounces, 
Virginia Snakeroot half an ounce, pour on them a quart of boil- 
ing water, and let it draw well by the fire. A wineglass full 
of this is to be given, from two to six times a day, according to 
circumstances. Where the prostration is great, add ten or 
twenty drops of laudanum to each dose. I prefer this remedy 
to sulphate of quinine; but where the quinine is most conveni- 
ent, give two grains of the powder, in place of each dose of the 
infusion above recommended. 

The next stimulant, in my estimation, is good spirit, espe- 
cially brandy. It is to be given, under the same regulations 
with the bark and snakeroot. Two or three table spoonfulls in 
water, or sugar and water, is a dose. It is a questionable 
remedy in the onset of the disease, but towards its close there 
is no doubt of its propriety. It is to be given to keep up the 
strength and restore the warmth, when it is failing. Many ar- 
ticles have been recommended for this purpose. Wine whey 
is the most common. But if alcohol is prescribed, let it be 
given in a way to be understood. Give a certain measure of 
brandy, and you understand your prescription. Do not be 
afraid of this remedy; if it is proper to use it at all, it should 
be used in sufficient quantity. In sudden attacks of spotted 



TYPHOID FEVER. 45 

fever; a mortal typhus which some years ago prevailed at the 
north, I have read, and I believe, that a quart of brandy was 
often beneficially given in a day. I have given half as much 
in my own practice ; but in most cases a few ounces in a day 
are sufficient. 

Ammonia or volatile alkali, has great reputation in these 
cases. Take sixty grains of volatile alkali, and two ounces of 
mucilage of gum Arabic. Rub them in a mortar till the solu- 
tion is perfect, and give a tea spoonful or two hourly. It is 
given where the prostration is great, and the patient sinking. 

These are the remedies which I recommend for typhus fe- 
ver. They are more numerous than I had expected they 
would be; but their number might be greatly increased. — 
They are by no means to be all used at once, but varied and 
combined, according to the directions given. If any error is 
committed, it is better it should be on the side of giving too few 
than too many remedies. 

But we are not yet done with this subject. Typhoid fever 
is a tedious disease, affecting, in different cases, various organs 
and tissues of the body, and producing local injuries requiring 
particular attention. Our patient must be nursed and sustain- 
ed with food, and his local disorders must have their appropri- 
ate remedies. 

The patient in typhus is not only sick; he is torpid and 
reckless. Every thing must be done for him, for he will not 
even call for the necessaries of life. He must be watched, 
watered and fed ; lighted, aired and turned in bed, for none of 
these things will he demand for himself. His clothing and bed 
clothes must be frequently changed, and for his own safety, 
and for the safety of his nurses, he must have room and free 
air. This is sometimes difficult to manage in cold weather, 
and the disease is consequently apter to spread in winter. The 
physician should always direct a free ventilation, and forbid a 
crowd around such patients. 

Food and drink, are also to be regulated without much reli- 
ance on the patient's desires. He is seldom thirsty, and in 
many instances the tongue will be found as dry as paper, and 
the patient deny having any thirst. His tongue should be 
moistened, and water offered him. He will often drink freely, 
and seem only to have remained thirsty from inattention. As 
a general rule, water is the best and the safest fluid which can 
be taken. It is hardly ever necessary to warm it even with a 
toast. The quantity of water, and other fluid taken, should 
be noticed by the nurse. It should not be large. A quart, or 



46 TYPHOID FEVER. 

thereabouts, is enough for twenty four hours. A larger quan- 
tity might cause diarrhoea, which is so troublesome in this fe- 
ver. It is difficult to give rules as to food. The patient will 
frequently refuse it for days together. What he takes should 
be nutritious and easy of digestion. Beef tea, has made a 
great figure amongst the dishes for the sick in typhus. It is 
very nutritious. In this country our patients are offered chick- 
en soup, which I think as good. I have no objection to a cup 
of tea evening and morning. It serves for food and drink, and 
is often more acceptable than any thing else. Milk and mush, 
or hommony, is a rich food for such patients. A great many ar- 
ticles might be mentioned here, but it is only necessary to say 
that they should not be too poor. The gum water and thin 
gruel, which Broussais thought the beginning and the end of 
remedies, are useless or pernicious. If the patient takes any 
thing, it should be nutritious ; for it is not to be forgotten, that 
typhoid fever is a disease which may continue^for many weeks, 
and that the patient cannot exist so long without nourishment. 
If his stomach can digest food, it ought to be taken. 

A sound discretion should be used in regard to food and 
drink in this disease. During its first stage, and while the fe- 
ver is high, let but little food be taken, and allow drinks more 
freely. When the disease has passed its highest point, and 
lingers and lingers it out, for weeks together, let the nourish- 
ment of the patient be a principal object. In extreme cases 
stimulants may be combined with food. Wine whey has had 
its day, and may, in milder cases answer well enough. But it 
is a poor and feeble remedy and still poorer food. Milk-toddy 
is a remedy of more value. In this, the articles combined may 
be estimated, and their strength proportioned to the necessity 
of the case. They are nutritious and supporting in a high 
degree. 

REMEDIES FOR PARTICULAR SYMPTOMS OR COMPLICATIONS, 
AS THEY ARE CALLED, IN TYPHOID FEVER. 

This disease, when it is protracted and of a high grade, 
commonly' brings on, or is attended with, some local disease. 
It seems to be thrown off, on some organ where it produces its 
peculiar effect. On the intestines, it produces little patches of 
inflamed spots, which sometimes end in ulcers, and even per- 
forate the bowels and cause death. On the brain and nerves, 
it produces prostration or paralysis, with coma or delirium. On 
the skin, it produces alight eruption of a distinct kind, which 



TYPHOID FEVER. 47 

is characteristic of the disease, but so slight as to require lit- 
tle attention. On the sacrum it produces ulcers, which have 
been denominated bed-sores, and attributed to the pressure of 
the patient's body, in lying too much on the back. I think they 
are not entirely dependent on that cause, but are a peculiar ef- 
fect of typhus. In the glands of the axilla, or groin, or near 
the angle of the jaw, it in a few cases produces abscess, which 
seems to terminate the disease. On the lungs, it also seems in 
some instances, to produce a low degree of inflammation in the 
last stage of the disease. 

In all these cases of local affection from typhoid fever, there 
is a peculiarity which belongs to the disease. It is no com- 
mon inflammation, but a typhus affection, which does not yield 
to the remedies for common inflammation. Our remedies are 
used with less effect, and less confidence than from the symp- 
toms we might expect. 

OF THE REMEDIES FOR COMA. 

This is frequently an embarrassing sympton. The brain 
admits of no enlargement or diminution, but always fills its 
bony case. If, by any means, the blood is forced on it, in a way 
to increase the pressure, a state of profound sleep or coma en- 
sues. If, on the contrary, the circulation fails to supply the 
requisite pressure to the brain, a state of fainting, resembling 
coma, takes place. Now these states, from causes so opposite, 
are not always easy to discriminate. In typhoid fever this 
discrimination is the more difficult, as the disease is one of 
weak action, and even in its resemblance to inflammation, the 
symptoms of inaction and debility predominate. When we 
find the patient affected with coma in typhus, and with diffi- 
culty so arouse him as to get him to speak, and see him drop 
off in an instant into a profound sleep, we are not to conclude 
as a matter of course, that his brain is oppressed with the 
circulating blood. The symptom may arise from a contrary 
state, or from some unknown cause, operating on the source of 
the nervous power. Coma is therefore to be treated with 
remedies of opposite kinds, according to the cause which in- 
duces it. The decision is often difficult, but must be made. 

If the coma takes place early in the disease — and accom- 
panies high fever, flushed face, and full pulse, the presumption 
is strong, that the brain is oppressed with too rapid a flow of 
blood into it. The remedies recommended are cold appli- 
cations to the head, cupping, leeching and mild cathartics. 



48 TYPHOID FEVER. 

These remedies, it will be seen, are modified, and not of the 
potent kind, used in inflammation of the brain. The full 
bleeding, ice water, and powerful cathartics used for that dis- 
ease, are never proper in typhus. Even the milder use of the 
same remedies, which I have recommended, is to be carefully 
observed and suspended if the pulse give way too rapidly. If 
the coma is removed, the remedy may be suspended, till it re- 
turns again. 

But I think coma in typhus, is seldom caused by too much 
pressure on the brain. If the pulse is feeble, and as I have 
often found it, slow ; if the face is pallid, and the patient quiet 
and still, I think no depleting remedy is proper. If there is a 
rapid pulse, moist skin, cold extremities, paleness, and yet 
burning heat of the body, with muttering and restlessness, 
still I think there is no pressure on the brain. The danger 
may be imminent, but not because of pressure on the brain. 
In these cases, and I think they are the most common in 
typhus I give stimulants. Opium is the first, and brandy 
is the next, to be chosen in these cases. They are to be 
graduated to suit the case. If the attack has been sudden, 
and the symptoms are decided and strong, give two grains 
of solid opium, or laudanum, or morphine of equal force. — 
This may be repeated in four hours, if necessary, and af- 
terwards according to circumstances. If the coma gives 
way, as it sometimes will, lessen the remedy, but do not aban- 
don it at once. Where the symptoms are milder, the remedy 
is to be accordingly reduced in quantity. Brandy is a pure 
stimulant, and, in these cases, the best we have to support the 
sinking powers of the patient. It is to be used most freely 
when the attack is sudden, two or three table spoonfuls, in 
sugar and water, may be taken hourly, till its effect is fully 
tested. It will be useless to try other stimulants if these fail. 
If the coma continues for days, the head should be shaven and 
blistered. I have seen this remedy appear to remove coma, 
and bring on better symptoms. The paralysis which some- 
times comes on in coma, admits of no immediate relief. Time 
and gentle exercise, with friction and moderately stimulating 
applications, should be relied on as our best agents. 

The affection of the bowels, which is commonly present, 
gives rise to some of the leading symptoms, and peculiar dan- 
gers of the complaint. Examinations after death have shewn 
that the small intestines suffer most, and that although they 
are sometimes free from injury, they oftener shew signs of in- 
flammation, and sometimes a perforation and escape of their 



TYPHOID FEVER. 49 

contents into the abdomen, has happened. Tenderness and 
slight tumefaction of the abdomen, are the common symptoms 
of this affection. In worse cases there is considerable pain, 
and the bowels become very much inflated, with noise and 
rumbling, from the passage of the air from one portion of the 
intestines to another. But when a perforation takes place, 
these symptoms are greatly aggravated. The pain becomes 
suddenly intense, and the abdomen swollen and tense. 

The remedies for these symptoms, it is on all hands agreed, 
have not proved themselves worthy of much confidence. I 
have seen leeching, cupping, and blistering tried, and can say 
but little in their favor. Where there is much pain and ten- 
derness, I prefer blistering. But in common cases, I depend on 
the soothing effect of an emollient warm poultice. It may be 
made of corn meal, wheat bran, or any other convenient arti- 
cle. It should be put in a bag, applied warm, and renewed 
from time to time. Heat in a dry form, by hot bricks or bot- 
tles of hot water, may be used with equal benefit. But where 
the pain is considerable, and especially where there are symp- 
toms of perforation of the intestines, laudanum is the reme dy. 
This is I believe a conceded point ; give two or three grains of 
opium, and after producing sleep and ease by this means, en- 
join a state of perfect quiet. There is still a ray of hope left. 

A new remedy is in a course of trial for this disorder of the 
bowels. The tenderness, which is thought to betoken an in- 
flamed, or ulcerated state of the intestines, is treated with the 
internal use of nitrate of silver, or lunar caustic. From half a 
grain, to a grain, dissolved in water, is given twice a day, for 
several days successively; or till certain dark colored stools 
pass from the bowels. This practice is said to have been suc- 
cessful, and I think it worthy of a trial. Spirit of turpentine 
is highly recommended by Doctor Wood, in these cases. He 
advises doses of from ten to thirty drops, three times a day. I 
think favorably of this remedy, and have used it in a few 
cases. I think the dose may be well extended to a tea spoon- 
full, and repeated once in four hours, till it operates as a ca- 
thartic. Used in this way, it operates less on the urinary or- 
gans, and I should expect better effects from it in the typhus 
affection of the bowels. 

Diarrhoea is a troublesome and dangerous symptom of ty- 
phus fever. It exists when the ulceration is present, and in 
some fatal cases, where it is not. We cannot therefore charge 
it to the ulceration or inflammation. It is a common symptom 
of typhus. It is agreed that neither cathartics nor laxatives of 
4 



50 TYPHOID FEVER. 

any kind, have any beneficial effect on this diarrhoea. They 
have been tried with sufficient perseverance, and I may say, 
injury- Astringents and anodynes form our main reliance. 
Take of sugar of lead ten grains, opium three grains, and make 
into four powders. These powders, are in moderate cases, an 
allowance for two days, give one evening and morning. In ex- 
treme cases, the whole may be given in one day. This remedy 
mav be continued as long as it is found useful. There is no dan- 
ger of its producing colic. Opium alone is a powerful reme- 
dy to check discharges from the bowels, in this disease. From 
half a grain to a grain may be given, two or three times a day. 
Other astringents may be tried. Gum kino, in doses of from 
five to ten grains, or tincture of kino, in doses of twenty or thir- 
ty drops, have been found useful. Galls, which contain tan- 
nin, the principal astringent substance of oak bark, are probably 
the best article of this kind. They may be given in powder, in 
doses of from five to ten grains, two or three times a day. 

Absorbents and alkaline remedies are useful in these cases. 
Take of prepared chalk two drachms, laudanum forty drops. 
Drop the laudanum on the chalk, and mix it together, till it can 
be divided into four powders, and give one every six hours. 
Ten grains of carbonate of soda may be given, four times a 
day, in place of the above pow T ders. Twent}- drops of lauda- 
num may be given evening and* morning, during the same 
time. 

Of these remedies for diarrhoea, opium or laudanum is un- 
questionably the most important. It affords, at least a tem- 
porary check to the complaint. The combination of prepared 
chalk with it is an excellent prescription, and, in moderate ca- 
ses, is to be preferred. The sugar of lead and vegetable as- 
tringents, are required, when the discharges are copious and 
watery, but the laudanum is still to be used as the case may 
require. 

Bed sores are not, in my opinion, the mere effect of pressure 
on the part. I have often met with them, and attended to them 
in their commencement. Before the skin is broken, I have 
noticed a tenderness and doughy softness of the part. The 
spot when it comes, is a real mortification, and too deep to be 
accounted for by pressure on the surface. These sores are to 
be treated with stimulants. When the} 7 first appear, a blister 
containing bloody serum, will be seen. After the blister is 
broken, the sore is pale, surrounded with a livid, reddish mar- 
gin. At this stage, I have used hot poultices of bran, made 
with vinegar; I have thought these arrested the mortification, 



fit 

TYPHOID FEVER. 51 

and promoted the sloughing, or separation of the dead flesh. 
When this flesh comes away, the sore will be found ragged, 
deep, and foul. It should be dressed with lint wet with tinc- 
ture of myrrh. Let the patient lie on his face, and fill the ul- 
cer with lint. Drop a sufficient quantity of tincture of myrrh 
on, and cover it with a plaster of simple ointment. It will re- 
quire daily dressing. 

These bed sores are a more serious malady than I have 
seen them represented. I have seen them penetrate to the 
bone, and cause exfoliation, and paralysis of the lower ex- 
tremities for life. The mortification often extends lower down 
than the sacrum, but never higher up. 

RECAPITULATION OF REMEDIES. fa 

1. Recollect, in the first place, that too many remedies are 
not to be given at the same time. Remember also, that this 
is a disease attended with great weakness, and that the reme- 
dies are to be mild, or strengthening. As a general rule, I 
draw no blood, I administer no active cathartics in typhus. 
This caution is the more necessary, as the inexperienced are 
commonly ready with these powerful, exhausting remedies, in 
every sudden attack of disease. 

2. Emetics. If, at its commencement, the disease is attended 
whith great sickness at the stomach, vomiting, or straining to 
vomit, restlessness and high fever, give an emetic of ipecac, or 
tartar emetic. The ipecac is the mildest, and is to be given in 
a full dose at once, say twenty or thirty grains in water. If it 
does not operate in ten minutes, give freely of warm waier 
till it does operate. Tartar emetic is more powerful, and may 
be given to robust persons, who are more capable of bearing 
its force. Give two grains of tartar emetic at once. If it 
does not operate* in half an hour, give freely of warm w r ater 
till it does operate. If the patient will consent, give the tar- 
tar emetic in a tea cupfull of warm water at once. Tartar 
emetic is slower in operating than ipecac. Both should be 
made to operate promptly, as they operate as cathartics, if 
they are not thrown off by vomiting. Very few cases of ty- 
phoid fever, require the use of emetics. 

3. Opium, is the great remedy in this disease. If emetics 
operate with violence, or commence operating as cathartics, 
give thirty drops of laudanum or a grain and a half of opium. 
These doses, or smaller ones, may be repeated according to 
the urgency of the symptoms. But this is not the only use 



52 TYPHOID FEVER. 

of opium, in typhoid fever. It is a leading remedy of itself. 
If the attack is sudden with delirium or coma, however rapid 
the pulse, or heavy the breathing, give opium. Give two 
grains at first, and a grain at a time afterwards, once, twice, 
or three times a day, according to circumstances. Its use is 
to still the agitation, support the patient, and hinder a fatal 
termination of the case. I have seen it produce the happiest 
effects, in cases in which the British physicians would have 
bled freely, the French would not have ventured beyond 
leeching and gum water ; and very few, in any part of the 
world, would have given the best of all remedies, opium. In 
milder cases opium is still the best remedy. Where the pati- 
ent is torpid, the pulse low, and the hands and feet cool, with 
some increase of fever and restlessness at night, give opium, 
in the form of Dover's powder. Ten grains of this powder, 
may be given in water at night. If the case is bad, repeat 
the remedy once in eight or twelve hours. If the bowels are 
disordered, or the pow.der causes vomiting, give twenty drops 
of laudanum in place of the powder. Finally, recollect that 
in the last struggle with the disease, when the powers of life 
are failing, opium is the most valuable of all remedies. Give 
it alone or combined, with brandy or other stimulants. From 
one to three or four grains of opium, every twenty-four hours, 
may be given at the discretion of the physician. As the dis- 
ease approaches a close, the remedy should be given in smaller 
doses at shorter intervals. No patient who can swallow, is 
too low to take opium., 

4. Cathartics. I have said, that active cathartics are im- 
proper in typhoid fever. It does not follow, that remedies of 
this class are always improper. As a general rule, give no 
cathartic of any kind, but when the bowels are confined, and 
there is pain and considerable heat in the early stage of the 
disease, give a mild cathartic. Give five grains of calomel at 
night. If it operates'a single time by the next morning, give 
nothing more. If it operates twice give twenty drops of 
laudanum. But if it fails to operate in twelve hours, give 
twenty grains of rhubarb. These form the best means of 
moving the bowels in this disease. But there are some per- 
sons, to whom calomel is a drastic, nauseating, and griping 
cathartic. If such require a cathartic, a dose of rhubarb 
alone may be substituted, or castor oil, if it be more accepta- 
ble. The rhubarb is the mildest and best ; the oil, frequently 
produces griping and sickness of the stomach. When the 
patient is very much exhausted, injections of soap suds, or 



TYPHOID FEVER. 53 

thin gruel may be used, and are sufficient, if they produce 
any natural discharges. The saline cathartics, such as salts, 
seidlitz powders, or magnesia, are less proper than those 
I have mentioned. It is to be remembered, as a general rule, 
that cathartics are not to be used without necessity in typhoid 
fever, and that some degree of costiveness is alwa} T s a good 
symptom in this disease. 

5. Tartar emetic. This is by far too active a remedy, in most 
cases of typhus. But there are cases in which the pulse is 
strong, and the heat and restlessness great. In such cases, one 
eighth of a grain of tartar emetic may be given once in two or 
three hours. In this manner of giving it, tartar emetic is not 
apt to produce vomiting, and is not an emetic. It is valuable 
in lessening the circulation, but is to be suspended if it operates 
on the bowels. 

6. 'Nitre, nitrate of f&tasli. This is a cooling remedy, often 
beneficial in the low, protracted, burning fever of typhus. It 
may be given in doses, of from five to ten grains in water, 
five or six times a day. If the pulse" is strong, and the skin 
dry, the antimonial mixture may be given during some part of 
the day ; say once in tw T o hours, till four or five doses are giv- 
en. These remedies, the tartar emetic and nitre, whether giv- 
en combined or separately, are to be carefully noticed and 
checked with laudanum, if they operate on the bowels. 

7. Cold. I consider the power we have of lessening the heat 
on the surface of persons in typhoid fever, one of our most valu- 
able remedies. This we can accomplish at pleasure, by the 
application of cold air, or cold water. Patients, in this fever, 
do not often complain of heat. They are, in a degree, insen- 
sible, and whether they are too hot, or too cold, is to be judged 
of, by the physician or nurse. If the hands and feet are cold, 
it will be premature to apply cold in any form. But during a 
great portion of every day, the heat will be found to be diffused 
over the whole body, and then it is proper to moderate it by 
artificial means. In cold weather, it is often sufficient to lessen 
or remove the covering for a time. When the skin is hot, and 
the patient restless, a stronger remedy is proper. Cold water 
should be applied by means of towels to the feet, hands, and 
face. It may be extended over the limbs, or even over the 
the whole body, if necessary. This application should be 
made, when the fever is at its height. It should be continued, 
till the heat is sufficiently reduced, and not so long as to give 
the patient much distress from the cold, or to reduce the pulse 
too much. It is commonly sufficient to apply the cold water. 



54 TYPHOID FEVER. 

from fifteen minutes to half an hour at a time, and once or twice 
a day is often enough to use it. This remedy may be used 
from day to day, as long as it is found necessary. It will not 
hinder the return of the fever, however cold the patient may 
be made, but like all of the remedies recommended in this fe- 
ver, it should be used with sound discretion and moderation, 
and I have no doubt of the great benefit it will accomplish. 
On the other hand, let no idle fears of taking cold, prevent the 
use of cold water in typhoid fever. If, in the application of 
the water, the linen and bed clothing get wet, do not have them 
changed, but let them dry, by the returning heat of the pa- 
tient's body. Where the heat was great, I have, in many in- 
stances, purposely wet the clothing, that the heat might be 
longer kept down, to a low degree. The power of cold is 
greatly increased by the application of cold air, by means of 
fanning. This should therefore be added to the cold water, 
when necessary. In all cases, the pulse should be examined 
from time to time, and not reduced so much, as to endanger 
the patient ; and it is never to be forgotten, that the powers of 
life are especially weak in typhoid fever. 

8. Acetate of Ammonia. This remedy, which is prepared for 
common, use, by dissolving carbonate of ammonia in common 
vinegar, has long been used in typhoid fever. It is gently 
stimulating and diuretic, and may be given as freely as it can 
be home, without operating as a cathartic. A table spoonful 
may be given at a dose, but if the vinegar has been strong, 
and thus required a large proportion of the ammonia for its 
saturation, the dose may be lessened. A dose of this lemedy 
may be given every two or three hours, and if it operates on 
the bowels, stop it for the time. This remedy may be given 
for many days in succession, but I think it best to suspend it, 
at least eight hours out of every twenty-four. 

9. Sweet Spirit of Nitre. This is an old remedy, but still 
worthy of its place in the treatment of typhus. It is so mild in 
its operation, that almost any quantity may be given safely. Its 
visible effect is seen in producing perspiration, and a free dis- 
charge of urine. The want of the discharge of urine is seen 
in every case of typhoid fever, after the first three or four days. 
A tea spoonful of the spirit of nitre, may be given in water, 
three or four times a day. If the discharge of urine becomes 
free, and the skin moist, stop the remedy for a time. 

10. Quinine. This remedy has but a limited place for its use 
in typhoid fever. When the patient becomes very low, I am 
in the habit of giving three or four doses of two grains* in com- 



TYPHOID FEVER. 55 

bination with laudanum, in the course of the day. But I pre- 
fer the hot infusion of bark and snakeroot. Take two ounces 
of. Peruvian bark, and half an ounce of Virginia snakeroot, put 
them into a pitcher, and pour a quart of boiling water on them. 
After this infusion has settled, pour off a wine-glass full for a 
dose. It may be given six times a day, with or without lauda- 
num, as the case may require. 

11. Brandy. Brand}', or alcohol in some form, is the best of 
all stimulants, and will in many cases be useful in typhus. 
Where it is our object to give support to sinking nature, we 
cannot prudently omit brand}', or other good spirit. Towards 
the close of typhus, there are many cases in which, from exces- 
sive discharges by the bow T els, or too copious perspiration, the 
patient is brought into great peril. In these cases, give bran- 
dy. Two table spoonsful in sugar and water, is a common 
dose, and may be repeated according to the necessities of the 
case. Where the prostration is sudden and early in the dis- 
ease, the brandy is the more necessary. I have in such cases, 
administered a pint or more, in the course of the day and night, 
with the happiest effect. This is the chief stimulant which I 
use in typhoid lever. A great many olhers have been tried, 
but as I think without any advantage. It may be used at any 
period of the disease, with a little care to avoid the period of 
most excitement. 

12. Cleanliness, fresh air, and pure water, are remedies for 
typhus. There is no excuse for the neglect of cleanliness, in 
typhoid fever. The clothing, and bed clothing of the patient, 
ought to be changed daily, or at least once in two days. — 
Where from poverty, this becomes impracticable, still cleanli- 
ness is to be rigidly enforced. Where the case does not ad- 
mit of cold bathing, the skin should be cleansed with warm 
water and soap. A free ventilation of the apartment of the 
sick, is also indispensible. This is to be constantly attended 
to, even in winter. Nor should the patient be allowed to for- 
get the use of cold water. If his bowels are disordered, he- 
will sometimes be thirsty, but he will more frequently forget 
to ask for water. A reasonable portion of cold water should 
be always offered to the patient, unless from extreme weak- 
ness, it is thought best to combine it with some stimulant. 

VS. Remedies for particular sy?nj)toms. Coma, or a state re- 
sembling a. deep sleep, in some cases, takes place at the begin- 
ning, and in others at the end of the attack. If this symptom 
occurs in the beginning, and there is great heat, and a full 
pulse, the application of ice to the head, with cupping or leech- 



56 MALARIOUS FEVER. 

lag, may be proper. But if this symptom takes place with cold 
extremities and feeble pulse, especially late in the disease, 
beware of the abstraction of blood, or the free use of cold ap- 
plications. On the contrary, use opium, brand}', and other in- 
ternal stimulants freely, and apply mustard and other stimu- 
lants to the surface of the body. Shave and blister the head, 
when the patient does not seem too much exhausted to wait for 
its action. Diarrhaa, with or without pain in the bowels, re- 
quires much of the physician's care in the treatment of typhus. 
The pain will demand the use of opium, and it is to be used in 
some form, to the extent of from one to four grains of opium in a 
day. To this, add two grains of sugar of lead, three or four 
times a da}', or from five to ten grains of galls in powder, 
two or three times a day. Tincture of kino is also a powerful 
astringent, and useful in these cases. From thirty to sixty 
drops may be given three or four times a day. Absorbents 
may be beneficially combined with opium. Take of prepared 
chalk two drachms, laudanum thirty drops; rub them in a 
mortar till they can be divided into lour powders. Give one 
of these powders every four or six hours. — Bed sores and absces- 
ses, require no treatment which is peculiar to typhus fever. — 
When inflammation takes place, with much swelling at the 
jaw, under the arm, or in the groin, apply warm poultices till 
matter is formed, and then discharge it with the lancet. — 
When the lower part of the back is found tender and swollen, 
apply hot poultices also. But here no suppuration will hap- 
pen, but a spot of mortification will take place, if it is not ar- 
rested. As soon as the mortification takes place, and the dead 
spot with or without broken surface is obvious, stop the poul- 
tice and dress with lint and tincture of myrrh, covered with a 
plaster of simple ointment. The dead flesh will slough out 
under this dressing, and the place gradually heal. After the 
ulcer becomes clean, and free from any portions of dead mat- 
ter, the offensive smell will cease, and the tincture of myrrh, 
may be discontinued. 



MALARIOUS FEVER. 

Fevers which arise from the effect of the heat of summer, 

on decaying substances in moist situations, have been termed 

irions. These are the periodical fevers of the temperate 

and torrid zones ; endemic in certain localities throughout these 



MALARIOUS FEVER. 57 

vast regions, and productive of more disease, than any other 
known cause. Their variety is so great, as almost to forbid 
the attempt to describe them. Of the one hundred and four- 
teen varieties of fever defined by Dunglison, no less than fifty, 
are such as are thought to arise from this cause. To this list 
of fifty, it would be easy to add a dozen more, from the cases I 
have myself witnessed ; but it is in my opinion, far better to 
reduce than to multiply these titles. 

.Medicine is not a science of demonstration ; and on this 
theme especially, physicians have agreed to differ. Without 
thinking that I shall settle a single dispute, or establish a sin- 
gle opinion, I shall attempt to reduce this subject to something 
like order, and to place my views, and my system of treatment, 
within the comprehension of every reader. 

Three principal varieties, comprise this great class : 

1. Yellow Fever. 

2. Bilious Remitting Fever. 

3. And Intermittent Fever. 

Few diseases would seem to differ more than the mild inter- 
mittent, and the yellow fever ; but tracing the intermittent 
through its forms of gradually increasing violence, to the bil- 
ious remittent, and this last, through its increasing violence 
and lessened remissions, till we meet with yellow fever, in 
which there are no regular remissions and paroxysms ; and 
finding that all stand in the same relation to the same cause, 
we are compelled to see that those who regard their numerous 
forms as mere varieties of the same disease, are supported by 
strong probability. In the study and treatment of intermittent 
and common autumnal or bilious fever, I have had ample op- 
portunity, but never could satisfy myself that there is a line of 
difference between them. In yellow fever, my experience has 
been slight ; but so far as it goes, and so far as I have been 
able to trace the analogies of these diseases in the descriptions of 
others, I think this formidable name cannot be separated from 
the other two. That the yellow fever of Philadelphia, describ- 
ed by Doctor Rush, and the same disease as described by acute 
observers elsewhere, is identical with the bilious fever I have 
treated in this place, I have no doubt. I therefore regard the 
whole of these varieties of fever, as one disease, requiring 
treatment suited to its various forms, but depending on the 
same remote cause. 



58 YELLOW FEVER. 



YELLOW FEVER. 

This is the highest grade of malarious fever ; bat as it does 
not occur so frequently in the temperate zones, and has not 
been much under my own observation, I shall offer on it a ve- 
ry brief essay ; reserving the principal remarks I have to make 
on its cause, to be treated of, under the head of bilious fever. 

I offer no argument in favor of the opinion, that yellow fever 
and bilious remitting fever, are but modifications of the same 
disease. This would be a waste of labor ; and I leave it to 
others. But I will say, that the facts which are known, and 
the analogies which suggest themselves, place the forms of ma- 
larious fever too close together to be easily separated. I 
therefore place }^ellow fever, first on the list of malarious fevers. 

Yellow fever occurs under the same circumstances with bil- 
ious fever, and I believe both commonly prevail at the same 
place, about the same time. Their symptoms so run into each 
other, that systematic writers commonly avoid the attempt to 
discriminate between them. 

I should be content to follow this example, but, that the dif- 
ference which does exist, seems to me to suggest important 
differences in the mode of treatment; and I think the subject 
cannot be perspicuously treated without being divided. 

It is important to note the differences, which exist between 
these varieties of fever. Bilious fever is a disease of par- 
oxysms and remissions — yellow fever in its first attack, is one 
great paroxysm, lasting for several days, if the patient survives 
so long. In bilious fever there is commonly a copious secre- 
tion of bile — in yellow fever this symptom also occurs, but 
runs into a vomiting of a brownish matter resembling coffee 
grounds, and known as black vomit. This is the leading symp- 
tom of fatal cases. In other respects, there is great similarity 
in their symptoms and effects. Both diseases occur in warm 
or tropical climates — in hot weather, after a lengthened pe- 
riod of heat, and their violence is thought to be proportioned 
to the heat of the season. It has been suggested that yellow 
fever is found to occur near the sea shore, where the tides are 
brackish, and this I think is generally true. The only cases I 
have seen, occurred in individuals who having in the summer 
visited Charleston, in South Carolina, came up the conntry be- 
fore the disease made its appearance. 

" The approach of yellow fever is often announced by a feel- 



YELLOW FEVER. 59 

ing of lassitude, heaviness, oppression, loss of appetite, and 
slight headache, which in a few hours, or on the following day, 
is succeeded by the violent symptoms of the disease. Some- 
times however, the attack is sudden and violent from the first ; 
the patient is seized with a faintness and giddiness of the head, 
with a slight degree of chilliness or horror, but never with a 
complete rigor or shivering; these feelings are immediately 
followed by a high degree of fever, and scorching heat of the 
skin, accompanied by acute, darting pains in the head and back, 
and a strong beating of the arteries ; the face and neck are 
flushed and tumid, the eyes red and protruding, and the coun- 
tenance grim ; great anxiety and oppression are felt, with an 
intense, burning pain at the stomach, with sickness and violent 
heaving, in which bilious matter is brought up; afterwards the 
discharge becomes a dark colored, and sometimes a bloody 
fluid.'' These symptoms continue from one to three or four 
days, without abatement, when the fever subsides, having gone 
through its first stage. The second stage begins with an 
abatement of the symptoms ; sometimes, says Doctor Mosely, 
"The symptoms are so mild that the disease is supposed at 
an end. This deceitful interval is short in the most violent 
cases, but is sometimes of many days duration. The disease 
returns without any premonitory sign, and assumes its most 
violent or fatal symptoms, frequently hurrying the patient to an 
untimely grave in a. few hours. The great distress at the pit 
of the stomach, with diffusion of bile in the system, and corres- 
ponding disease found after death, in the liver and stomach, 
characterize this disease, and* mark its identity or close alli- 
ance to bilious fever. 

The disease is not always of the violent and rapid type 
above described. The few cases I have witnessed, were slow 
in their progress, and we have the high authority of Doctor 
Mosely, for the fact, that there are cases which do not run to a 
regular termination, but are "lengthened out, and at last con- 
verted into a remittent of great duration, of most difficult cure, 
and tedious recovery." Trusting that my readers may never 
meet with a case of this fatal disease, I cut short this account 
of its symptoms, and ask permission to introduce to their no- 
tice a short account of my own experience in yellow fever. 

In the year 1S40, having been on a trip to the North, I ar- 
rived in Charleston in August, where I remained one nio^ht. — 
A week or ten days afterwards in Milledgeville, I became 
sensible that my health was deranged. Sluggishness and op- 
pression about the stomach, are all the symptoms I recollect ; 



60 YELLOW FEVER. 

but these were so considerable as to be noticed by my friends. 
Fever came on about the fourteenth day. Severe pain in the 
back and limbs, fullness and dull pain in the head, with 
slight chilliness and restlessness were experienced. These 
symptoms became worse, and were attended with eructations 
of air in quantity. A copious flow of limpid urine, and a dry 
skin, with but little thirst, complete the prominent symptoms 
of the first two days. 

For three days the symptoms were about the same, and it 
was not till the fifth day, that the fever subsided. My skin, 
and the whites of my eyes, had become of a deep orange col- 
or, and the urine and discharges by the bowels were of the 
deepest orange yellow ; exceeding any thing I had ever seen 
in bilious fever. I felt no particular pain, but sensations of 
peculiar oppression about the stomach, which did not subside 
for many weeks, and indeed after a lapse of six years, are still 
frequently felt. 

I continued in this state for six or seven weeks ; not confin- 
ed to bed, but with no improvement in feeling or complexion. 
At length, accident threw me into great effort under great men- 
tal excitement. I sunk from this, into a profound sleep for 
eight hours. I was aroused with vomiting, almost incessant, 
and intolerable thirst. I was in no severe pain, and felt but 
little nausea, but every thing I swallowed returned unaltered. 
The water I drank, which I received in my hand to examine 
for black vomit, returned nearly as cold as it was swallowed. 
With these symptoms, a rapid pulse and haggard and swarthy 
countenance, few who saw me*expected my recovery. 

The legislature was in session, and Doctor White who was 
in attendance, called to his aid, several eminent physicians. — 
They decided to give me thirty grains of calomel and three of 
opium, and to repeat it hourly till a changed occurred. I took 
but the first dose. About an hour afterwards, I vomited with 
a distinct sensation of the contents of the first intestine, pass- 
ing into the stomach. I received the discharge in my left 
hand — it was the signal of life or death — guess my relief in 
seeing it, of well formed yellow bile. The load I had felt at 
my stomach for nearly two months, was gone — I was out of 
danger — I took nothing more. 

The next case I shall mention, was attended with a fatal 
result. A gentleman who came from the city of Charleston, 
to Milledgeville, after about a week, was attacked in the same 
manner. His fever lasted about seven days, when a crisis 
seemed to have happened. His recovery was but an illusion ; 



YELLOW FEVER. 61 

for in a day or two, he was attacked with vomiting, and in a 
few hours the evidences of black vomit were clear. He sunk 
under it in about two days. 

I need not say much more in the description of yellow 7 fever. 
It is a continued and violent fever, lasting from two to ten or 
fifteen days. It is, as it were, one great paroxysm, and often 
produces death, by its first onset, or by the internal damage 
it has done. The black vomit, and yellow skin, do not occur 
early enough to be relied on as the guiding marks of the dis- 
ease Time and circumstances may give a strong probability ; 
but I doubt whether the symptoms alone will at first point out 
the disease to the most experienced practitioner. This is less 
to be regretted than might be expected, for it produces no al- 
teration in the practice. The usual remedies for a fever of 
hicrh excitement, will be proper in this disease. The symp- 
toms vary in different cases, and death does not always occur 
in it, earlier than in bilious fever. It may have remissions and 
and exacerbations, but these are not of sufficient importance or 
regularity, to be considered characteristic of the disease. 

Yellow fever is, I have no doubt, commonly a disease of 
strong action and high inflammatory grade. But there are 
cases, which have given countenance to the typhus character, 
and stimulating treatment urged by some enlightened physi- 
cians. There are unquestionably many cases in which the 
patient sinks under the first onset, and the physician has no 
choice but amongst stimulants for remedies. 

Treatment. Regarding the disease as of high excitement, the 
treatment in such cases is simple. 

Bloodletting, if practiced in the first stage, will be a power- 
ful remedy, and is highly recommended. 

Emetics, or what is preferable, broken doses of tartar eme- 
tic and nitre, should follow 7 . This powerful means of lessen- 
ing the circulation, evacuating the stomach, and keeping with- 
in bounds the febrile heat, should be used according to the 
necessities of the case. In my own case I relied on this 
remedy, and was very sensible of its beneficial influence, 
but, probably used it two sparingly. 

Calomel. This is probably, the most important of all reme- 
dies in yellow fever. My own experience of it was most 
triumphant. Had I used it in the same efficient way, at the 
first attack, I might have been saved from the last. It is not 
a mere cathartic in this disease. Its powerful action on the 
liver is, I have no doubt, the important consideration. Other 



62 YELLOW FEVER. 

cathartic medicines may be added, but the calomel should 
never be excluded. 

Cold. The application of cold by means of ice or water, is 
a well established means of relieving 3^ellow fever. There 
is little danger of carrying this too far, in the first stage, if the 
patient is allowed to stop it, when it becomes disagreeable. 
No remedy is better established, or more approved than this. 

There is in this, as well as other fatal disorders, a last 
stage, in which although there is hope of benefit from reme- 
dies, those we have been speaking of are no longer to be al- 
lowed. This stage, in some instances, comes on suddenly on 
the first attack. The pulse becomes feeble, the extremities 
cold, the mind wanders, and death is impending. Here 
stimulants will find their place. Sinapisms and warm dry 
applications, spirit, ether and camphor, or other remedies, are 
to be used according to circumstances. But by far the best 
remedy is — 

Opium. This remedy is to be given in sufficient doses. 
It may be given in combination with the stimulants mention- 
ed, or with colomel, where it is not too late for the administra- 
tion of that remed}'. From three to six grains in twenty-four 
hours, will often be but a reasonable prescription. 

Quinine has not proved so valuable a remedy in this, as in 
bilious fever. I should have less faith in it, than in the pure 
stimulants which have been mentioned. This is the testimony 
of those most entitled to speak from experience on this sub- 
ject. But I think the milder cases, will furnish a proper field 
for further experiment with this invaluable remedy. I should 
not fail to put it to the test, whenever a slight remission pre- 
sented itself. 

Nutritious food should be allowed, as soon as the fever sub- 
sides, and the appetite will receive it. It is easy to err on the 
side of taking too little in this case. 

There is, I should think, but little danger of erring very 
widely, in the treatment of medium cases of yellow fever. 
It is a disease of high excitement, with full pulse, great heat, 
and pain, and will call for depleting and cooling remedies. 
These remedies, with a special refference to mercurial cathar- 
tics, make up the treatment. They should be used freely, 
and not laid aside too soon. Where the symptoms are those 
of high inflammatory fever, the treatment may be urged with 
fair hopes of success. 

Black vomit, the characteristic symptom of this complaint, 
is seldom recovered from. When it occurs early in the dis- 



YELLOW FEVER. 63 

ease there is less hope. A gentleman who had remained in 
Savannah, during the prevalence of this disease in 1820, sat 
down to write a letter to his friends. He began by congratu- 
lating himself, that he had been spared till the season had 
nearly stayed the pestilence — a sudden sickness came over 
hi m — he threw up a quantity of the matter of black vomit — 
he was a corpse in a few hours. Thus insiduously does this 
fatal symptom arise. It occurs in cases where it is least ex- 
pected, and is often the first symptom of the disease. No one 
pretends to have discovered a remedy for it. 

RECAPITULATION OF REMEDIES. 

1. Stimulants, Where the patient is prostrated suddenly on 
the first attack, or sinks to a dangerous state of debility after 
several days, stimulants are to be used. The first of these 
is brandy, or other good spirit. It should be given according 
to circumstances, from a gill to a pint in a day ; giving more 
where the prostration is great. Opium should also be given, 
and other stimulants may be added at discretion. Where the 
skin is cold, and the circulation in the capillary vessels is im- 
peded, so that a purple tinge is more or less visible, let sinap- 
isms, hot applications, and other external stimulants be used. 

2. Bloodletting. A full bounding pulse, flushed face, pain in 
the head, or in any vital organ, or all these symptoms together, 
demand the use of the lancet. Let it be used, but not abused. 
Draw blood to moderate the symptoms, take a pint, or in the 
event of pressing danger, a little more. But recollect that 
there are other remedies to follow, and that these will bring 
down the circulation, if it is not sufficiently reduced by blood- 
letting. 

3. Emetics. Two grains of tartar emetic, every half hour, 
till it operates as an emetic, is a powerful remedy, and often 
proper in the high fever which ushers in this disease. Where 
the fever continues for a day or more, with great heat, give a 
table spoonful of antimonial mixture hourly, or less frequently, 
as the case may require. This remedy is to be laid aside 
when the fever subsides, or its operation has been active. 

4. Calomel. This is an invaluable remedy in yellow fever. 
It is slow in its operation, and may therefore be given after 
bloodletting and emetics have been used. But it is not to be 
delayed. Give ten grains and repeat the dose every twelve 
hours, till it produces discharges of bile from the bowels. If 
there is great prostration, combine opium, but do not omit the 



64 BILIOUS REMITTING FEVER. 

calomel. Thirty grains of calomel and three grains of opium 
in pills, arrested a vomiting in this disease which would have 
destroyed me, in a single da}'. I felt that I was cured in less 
than one hour. 

5. Cold applications. The burning heat, which attends yel- 
low fever, calls for cold air and cold water. It is not the 
shock of a shower bath, but the extensive application of cold 
water to the surface of the body, which I recommend. Let 
it be used freely and without fear. It has been fully tested 
and is approved. 

6. Opium. This remedy may not be often required in yellow 
•fever. But where the stomach is too much irritated to retain 
any thing, a strong dose of opium or laudanum will in some 
instances tranquilize it, in a remarkable manner. Where 
there is prostration with paleness of the surface, give lauda- 
num. Do not give it when there is great heat and manifest 
inflammation, especially if the fever is rising ; but if the fever 
is on the decline and the symptoms alarming, do not fail to 
give opium or laudanum. 

7. Quinine. This remedy, whether in its crude state in the 
Peruvian bark, or its elegant form of quinine, as now used, is 
not much relied on in yellow fever. I think it is too much 
neglected, and I should not fail to give it whenever a remission 
of the fever could be obtained. I should also give it in the 
prostration of violent cases, where the powers of the system 
seemed to be failing. Let from two to five grains be given 
hourly, in such cases, till twenty or thirty grains are taken. 
This is enough for one day in the worst cases. If it is given 
in milder cases the quantity may be lessened. 



BILIOUS REMITTING FEVER. 

The frequent occurrence, wide extent, and formidable char- 
acter of this disease, justify an accurate account of its causes, 
and treatment. I have said that the varieties of fever which 
arise from malaria, whether it be a real or imaginary cause, 
cannot be accurately defined. Yet I have divided the subject, 
and have no doubt, shall be able to treat of it, more perspi- 
cuously and moie usefully by so doing. By far the most im- 
portant of these divisions is bilious fever, under which name I 
propose to treat of all malarious fevers having remissions and 
exacerbations. This class will include, the autumnal, bilious re- 



BILIOUS REMITTING FEVER. 65 

mittent, pernicious intermittent, congestive, and I know not 
how many more varieties of fever which have been described 
by authors. 

Intermittent fever is excluded from this class, because of its 
mild character, and long duration, but there will occur cases 
which it will not be easy to assign to one of these classes rather 
than the other. Arising from the same cause, they run insen- 
sibly into each other, so that there can be no perfect discrim- 
ination. 

HISTORY OF BILIOUS FEVER IN MILLEDGEVILLE AND ITS 
NEIGHBORHOOD. 

In a state of nature this was a rich, variegated country, 
covered with majestic forests and tall waving grass. The 
low lands on the sides of the streams, were covered with 
heavy cane brakes, or unbroken beds of reeds. Such was 
Milledgeville and the contiguous country till about the year 
1807, when it became the residence of the white man. In 
this state of primitive grandeur and unequalled beauty, this 
country was decidedly healthy. I was here soon after the 
Indian inhabitants had left it. I witnessed its rapid settle- 
ment — the destruction of its forests — the extermination of its 
canebrakes, its reeds and its grass — and the laying bare of its 
bosom to the sun. 

Bilious fever appeared as suddenly, as the face of nature 
had been changed by the hand of man. For eighteen years 
it was a formidable epidemic, during the summer and fall 
seasons. The mortality was greatest where the lands were 
most fertile. Milledgeville, located on a spot of great fer- 
tility, was perhaps the greatest sufferer. No tables of mor- 
tality were kept, but I cannot be mistaken in placing the 
deaths from bilious fever alone, as high as five per cent of its 
whole population, each year from 1S08 to 1812 or 13. This 
mortality happening in a few months, gave to the disease the 
terror of a pestilence. Forty years have now elapsed, and 
great has been the change in the face of this country. It has 
been reduced in many places almost to sterility. Its gullied 
hills and deeply sanded bottoms have become dry. The bil- 
ious fever has almost ceased its annual visit. The annual 
deaths in Milledgeville from this cau^e, which I have said 
were at one time as many as five in the hundred of its popu- 
lation, have gradually diminished, — so that within the last five 
years they have not exceeded one in two thousand. The 
5 



66 BILIOUS REMITTING FEVER. 

facts which have attended this great change cannot be un- 
interesting. 

CAUSES. 

If there were no summer, there would be no bilious fever. 
But to w 7 hat degree the thermometer shall rise, or how long 
continue, at any degree of heat to produce this disease, is not 
ascertained. The process is, I think, not sudden. I have 
seen in the month of June, the river overflow its banks and 
subside under the greatest heat of summer. No fever ap- 
peared for five or six weeks, but its onset was then sudden 
and violent, and it only subsided on the coming of frost. No 
example is given of the appearance of this disease in winter, 
except in persons who had contracted it beforehand; nor is it 
agreed, what length of time the infection may remain in the 
system. 

So far as it regards climate, it appears that summer heat, 
and moisture must combine to produce bilious fever — before, 
absolute dryness or thorough w~et, it equally disappears. I 
have seen bilious fever appear in July, disappear in the driest 
and hottest weather of August, and re-appear on the coming 
of rainy weather in the next months. These observations are 
not new. In the East, it has been remarked that the over- 
flowing of the Delta of the Ganges and Indus, is the signal of 
returning health to their inhabitants. 

MALARIA. 

An Italian physician has the credit of having suggested as 
the cause of bilious fever, an effluvium or emanation from 
decaying vegetable matter in marshes. Chemistry has never 
detected this malaria, and many are disposed to doubt its ex- 
istence. The circumstances connecting the existence of bil- 
ious fever with the state of adjacent lands or marshes have 
been investigated with great care, and the belief that the cause 
of the disease is to be found in the state of these places, is 
general. I am free to confess, that the facts I have witnessed 
go far in my mind, to corroborate this doctrine. At the same 
time I desire to say, that I see no proof that the production of 
this malaria, or miasm is a mere chemical process. We know 
enough to satisfy us, that there are in nature, besides gravity, 
other powerful agents which totally elude our research. The 
cause of small pox, which emanates from a diseased person, 
and, at some distance, produces the same disease in one which 



BILIOUS REMITTING FEVER. 67 

was well, has defied chemical detection as much as the ma- 
laria of marshes. Whether it is a fluid or aeriform matter, or 
an influence extending itself on principles yet unsuspected, is 
entirely unknown. 

What I wish to enforce is, that so far as the cause of bilious 
fever is concerned, we know enough of it, to protect ourselves 
from its power in almost any country: and that he who can 
place this knowledge in the custody of those to whom it will 
be most useful, will render an important service to mankind. 
To aid however slightly, in this great object, I shall without 
much comment, mention the principal facts I have witnessed, 
which carry in their mere statement, important information. 

Locality. The people of the south almost universally be- 
lieve, that bilious fever arises from the influence of humid 
places. Mill ponds are universally regarded as nuisances, 
and many have been legally abated, on the ground of their 
causing fever. The valleys of rivers, and smaller streams, lie 
under the same distrust. Ponds of water, especially lime 
sinks, are perhaps the most distrusted. A vast experience 
and enormous loss of life, have given strength to these opin- 
ions. They are in the main, well founded. But there are 
many places which seem to be harmless, in spite of the exis- 
tence of these causes, and it is of some importance to know 
why it is so — why one pond should produce disease and an- 
another not. A pond whose water is always of the same ele- 
vation and covers the same ground, will not produce fever. 
One surrounded by alluvial sands, and having for its bottom a 
white or light blue clay, though its soil for a foot or more be 
of half decayed aquatic plants, may dry up in the heat of 
summer and yet produce no fever. I have witnessed many 
examples of this ; in the country stretching across a few miles 
below the falls of our rivers, where the long leaved pine covers 
the surrounding country. In this same region, mill ponds are 
equally innocent. If their streams are short and do not arise 
in the granite hills, and they are not too near the river, they 
may rise or fall, be full or empty, and the surrounding inhabi- 
tants will be unaffected. The sides of these streams running 
through this country, present in rare instances a mild re- 
mittent. 

Milledgeville and its neighborhood, which form the scene of 
my observation?, afford the greatest variety of soil and situa- 
tion. The town lies on a primitive foundation, with soil of 
rich clay loam, subject to wash into deep gullies when the sur- 
face is once broken. The country around, and especially 



68 BILIOUS REMITTING FEVER. 

along the streams which enter the river near this place, is hil- 
ly and has the same predominant feature of a soil formed on 
tenacious clay. Lower down, the face of the country sud- 
den ly changes. The margin of the ocean was once here, and 
the rolled gravel, and accumulated sand, form soil for the lof- 
ty pine forests which extend to the seaboard. A close obser- 
vation shows that the change for a few miles is only on the 
surface, and that on penetrating the earth only a few feet, the 
rock is still in its original position. It is no longer granite, but 
changes to gneiss, mica slate, and clay slate, in a few miles. 
Through such lands the streams are crooked, and the hills ab- 
rupt ; but no country is better drained, better watered or more 
healthy. I know many places where the inhabitants have for 
half a century, lived totally exempt from bilious fever, even in 
its mildest form. 

Far different has been the experience of those who settled 
the richer lands, founded on clay and presenting a more in- 
viting aspect. The rich loam was no sooner broken, than fe- 
ver made its appearance. It was more violent along the sides 
of the streams, and worst where the valle} T s of those streams 
were wide, and too wet for the growth of crops without drain- 
ing. The cane which grew thick on these lands, was suddenly 
destroyed and the soft mud laid bare to the sun. These pla- 
ces were regarded as the chief source of the malaria, which 
annually produced such alarming effects. But the fevers of 
those years, did not always seem to depend on contiguous 
marshes, rivers or mill ponds. The newly broken soil in the 
clay lands, seemed in some instances, to produce the same ef- 
fect. The gray sandy lands when remote from marshes, w r ere 
most healthy, and as I have remarked in some cases entirely 
exempt from this disease. 

The inhabitants of Milledgeville suffered their full share, 
of the ills of a bad location in a new country. Situated on the 
Southwest bank of the Oconee River, on a soil very fertile, 
and formed chiefly of clay, it could not well escape the evils 
of a sudden settlement and clearing of the land. The sloping 
banks of the river, the water of which rises nearly thirty feet 
in the highest freshets, would, when rendered bare of its origi- 
nal rich vegetation, be a great source of the causes of disease 
of which we have been treating. It is certain that at the time 
the population of about two thousand, was cutting down the 
forest, erecting houses, plowing new fields and allowing their 
cattle and horses to destroy the reeds and grass which were 



BILIOUS REMITTING FEVER. 69 

the natural covering of the land, they suffered the annual in- 
vasion of bilious fever in its worst form. 

Districts of country. From the earliest times, the term sicJdy 
country, has been applied to places subject to the various 
forms of bilious fever. Doctor Watson in his summary of the 
opinions of enlightened travellers of the present day, says that 
the inhabitants of such countries are represented as being 
"puny, sallow and sickly; feeble in body and spiritless in 
mind; having yellow faces, swelled bellies, and wasted limbs; 
subject to dropsies and fluxes; phlegmatic, melancholy and. 
short lived." This picture is drawn from the most unhealthy 
regions, but it must be acknowledged, we have many places 
whose inhabitants exhibit too many of the symptoms de- 
scribed. Every one w T ill acknowledge the importance of 
avoiding evils so appalling. 

Sicily was considered by the Greeks an unhealthy country, 
and one of their writers adds, lhat the most sickly parts, were 
those in which the wells were shallowest. This remark holds 
true within the compass of my observation, with but few 7 ex- 
ceptions. The islands of our coast which are composed of 
sea sand, and have on them only the water which falls in rain, 
are healthy, though the wells are very shallow. But there are 
exceptions, to the healthfulness of the islands of our sea coast. 
Those of South Carolina are considered very unhealthy. The 
cause of this, has not been well ascertained. I have no doubt 
that a stratum of marl or clay, will be found, at a greater or 
less depth, below the surface, of these sickly islands. This is 
the common cause of the unhealthiness of similar localities. 

The formation of peat is hindered in southern latitudes by 
the extremes of heat and drought. It never occurs in places 
sometimes overflow' n and at other times dry. The presence 
of peaty earth proves the absence of putrefaction. The great 
Dismal Swamp, at the south of the Chesapeake Bay, has been 
often referred 1o, as the most extensive and healthy region of 
peat in the south. [ know thousands of acres of similar lands 
located in our sandy pine woods, which have proved equally 
innocent. But I have witnessed the clearing of some of the 
lands, around the streams furnishing these peat mosses ; and the 
consequent frequent overflow of them by muddy water and 
sand, and finally a change in the people of the neighborhood 
from health to sickness. 

But we will return to the general fact, that very shallow 
wells indicate a very sickly country. To this I know no ex- 
ception, except ouch as have been mentioned. The sea coast 



70 BILIOUS REMITTING FEVER. 

of the Carolinas and Georgia, give extensive exemplifications. 
The soil of this whole region is sandy, but is, I believe, uni- 
versally underlaid by a stratum of aliuvial^ clay, sufficiently 
compact to hold water. In many places this clay is exposed, 
furnishing the rice lands of this extensive district. 

Leaving the seacoast and penetrating the country thirty or 
forty miles, the sand hills rise, the wells get deeper, and the 
people have another and higher grade of health. This region 
is, in Georgia, fifty miles or more in breadth, and is an exceed- 
ingly healthy country. It is unfortunately unproductive, and 
thinly inhabited, and will so remain, till skill in cultivating 
this interesting section shall develop its capacity to sustain a 
dense population. 

Ascending the streams, we next meet with that remarkable 
region, called in Georgia, the rotten limestone. From the sea- 
coast of New York, it extends, gradually winding and rising 
in elevation above the sea, till in Georgia it has become nearly 
two hundred feet above the tide, increasing in breadth and ele- 
vation as it progresses south and west. This whole region, 
extending to Mexico, is considered unhealthy. Many parts of 
it have high hills and deep wells, and are healthier than other 
places in the same region, but there is no warrant for the en- 
joyment of health and extension of life in such a region. 

The composition and structure of this extensive, fertile and 
sickly region is such, that the streams through it are very lev- 
el, their vallies subject to overflow, and in many places lime 
sinks, developing large streams of water under ground, run- 
ning to some larger neighboring stream. The surface of the 
country is sandy, and in some places, elevated into hills; but a 
substratum of clay or marl at various depths from the surface, 
detains the rain water which flows perpetually from the sides 
or bottoms of the hills. The water of these springs is offen- 
sive to the taste, and in some places, has the smell of stale ani- 
mal matter. This putrid smell is probably derived from the 
beds of marine shells, through which this clear water has 
passed. The whole arrangement and composition of the earth 
in this region favors dampness, and produces the sickliness so 
generally feared. 

Proceeding up the rivers we next come to a range of ele- 
vated and well drained pine woods, free from marl, though 
abounding in porcelain cla}^ This clay, in greater or less pu- 
rity, is seen in the banks of streams, the bottoms of ponds or 
on the tops of hills. It seems to be a transition from the gran- 
itic to the rotten limestone region ; and is as healthy as any 



BILIOUS REMITTING FEVER. 71 

part of the country. It extends from Augusta to Milledge- 
ville, and onward as far as I have examined, and is from five 
to ten miles in width. This region is comparatively poor, but 
under all circumstancesmore free from bilious fever, than the 
country above or below it. Mill ponds, or natural ponds, in 
the elevated plains are harmless, under any degree of damp or 
drought. This region is thinly inhabited, by a population who 
live, from generation to generation, without experiencing bilious 
or intermittent fevers. 

We next come to the great primitive formation East of the 
Alleghanies. It is a granite region, though infinitely diversi- 
fied in appearance. The country is rolling and well drained, 
and when cleared and brought into tillage by the planter, very 
healthy. This country, extending from the tops of the moun- 
tains to the last granite falls in the rivers, is the strength and 
the pride of the South. From Virginia to Georgia it covers 
about one half of the country east of the mountains, and is 
probably not excelled, in climate and situation, by any part of 
the earth. It has no limestone, but cla}^ and all the elements 
of granite combined in a thousand ways, ensure a lair amount 
of fertility. But these elements and their vegetable products, 
give rise under certain circumstances to bilious fever. Mill 
ponds, badly drained valleys, oozy and damp hill sides, and 
probably many ill drained but cultivated fields, prove fruitful 
sources of disease. In all this region there is great difference 
m the healthfulness of neighboring places; but it will gener- 
ally hold good, that places well drained and sufficiently re- 
moved from ponds or similar nuisances, will be healthy. 

But experience has shown that a residence near our great 
streams or wide overflowing bottoms, in our primitive region, 
is unhealthy. In this region mill ponds are (earful nuisances. 
These causes are worst where the country has been but lately 
brought into cultivation. They diminish as the country grows 
older. The overflowing of river lands, and their subsequent 
drying in hot weather, has been regarded as the most certain 
cause of bilious fever. I have again and again witnessed fever 
which I thought arose from this cause. But the rocky bed of 
a rapid river, being laid bare by extraordinary drought, has 
been found as capable of producing fever as the muddiest 
swamp. It is not then in proportion to the quantity of mud. — 
The slimy rocks of dried up rivers, have appeared to produce 
diseases as violent and as fatal, as any produced by swamps 
of any kind. As a general rule, it may be said, that places are 



72 BILIOUS REMITTING- FEVER. 

unhealthy in proportion to their contiguity to extensive deposits 
from streams which become diy in the heat of summer. 

2. Elevation — Distance. Admitting that the sloping banks 
and fertile bottoms of streams, and the margins of ponds, are 
in summer, productive of the cause of bilious fever, it becomes 
an important question, in choosing a residence, to know the 
safest locality. I have pointed out the circumstances pro- 
ductive of fever, and those free from the danger, and it is now 
my purpose to say something of the distance, and elevation 
which may be relied on as a protection. Three miles has been 
assumed as the nearest safe distance from a spot producing 
malaria. My own experience places the line of safety far 
within this limit, but having seen the range of bilious fever 
near the same river, vary in different years in proportion to 
the severity of the disease of the season, I conclude that the 
danger is more extended, when the product of the cause is 
greater or more powerful. I have compared it with the ema- 
nations of putrid effluvia from decaying animal substances- — 
they become w r eaker in proportion to distance. I have never 
seen bilious fever, as much as two miles from the place which 
I considered as originating its cause, and I believe there are 
few places which ever produce it at so great a distance as a 
mile and a half. It has been said that the cause of this dis- 
ease, moves with the wind, and continues near the surface of 
the earth — that an upper story is safer than a lower story of 
the same house. This does not correspond with my observa- 
tions. The room or building nearest the nuisance, will proba- 
bly be first attacked; but I have never seen the residents of an 
upper story, less affected than those who resided or slept be- 
low. Nor can 1 confirm the opinion of some men of high 
standing, that this miasm cannot cross a pond or river. The 
Oconee river, in the alluvial country below Milledgeville, runs 
in several places at the base of high bluffs, extending back to 
a great distance in a well drained and healthy country. These 
bluffs are considered a more dangerous residence, than the 
rich bottoms on the opposite side, where the only apparent 
cause of the miasm is to be found. 

To what elevation the cause of fever may rise, is a question 
yet unsettled ; and I have witnessed no facts directly bearing 
on this point. Between creeks or rivers, there must be a point 
of greatest elevation ; and this point is apt to be at a medium 
distance between them. This elevation above the river, with- 
in a few miles of this place, is from one to four hundred feet.— 
On each side of Fishing Creek, which empties into the Oconee 



BILIOUS REMITTING FEVER. 73 

immediately below Milledgeville, there arise hills of this height, 
overlooking its valley from each side. I have many times, in a 
tour of professional labor, made a circuit of twenty miles up 
on one side, and down on the other of this stream. It was at 
several points easy to behold the valley, from one to three 
miles from hill to hill, spread out like a map for several miles. 
On the tops of the hills, on which there run public high ways, 
there was not, nor ever has originated, a bilious or intermittent 
fever. No wind from the valley, although so near, has ever 
spread the pestilence so far. It has been interesting to notice 
the exactness of the limit which seemed to be assigned the 
disease. I have several times noticed two settlements, one 
hundred yards apart — the most distant would escape alto- 
gether, while that which was only one hundred yards nearer, 
suffered the disease in almost every member of the family. 

It has been said, that villages are more subject to the visit 
of agues, than cities — I will add that a single residence in the 
country, is more subject than either. If the decomposition of 
vegetable matter, by warmth and moisture, especially in com- 
bination with a clay soil, is the cause, these facts will appear 
as matter of course. The suburbs only of a great city can be 
much exposed, and a village can have but little protection — 
every house is near the suburbs on one side or the other. 

I have said that intervening water affords no protection 
against malaria ; and I think that intervening houses are equally 
insufficient to arrest its progress. Intervening hills are enti- 
tled to more confidence. It has long been observed in the 
United States, that the summit of the nearest, hill to a river val- 
ley, is the most sickly residence which can be chosen. Any 
part of the valley has been justly thought more healthy. In 
1813 — 14, I attended a family located on one of these pictu- 
resque hill tops, elevated perhaps one hundred feet above, and 
distant aboui half a mile from the river. The family, with 
scarcely an exception, had every year a violent attack of bilious 
fever, and two or three died from it. I advised a removal over 
the hill ; but the gentleman, whose possessions did not extend 
far, could only accomplish it by moving lower down where the 
hill was narrower. He in this way secured a hill between 
him and the river valley, but gained little in distance, and was 
on a place at least fifty feet lower than that he had left. His 
new residence proved entirely exempt from billious fever, and 
is still inhabited and healthy. 

Mist, or fog, has been thought to cause, or to serve as a means 
of transporting the cause of fever. I believe this idea is ex- 



74 BILIOUS REMITTING FEVER. 

ploded amongst those whose opinions would entitle them to 
much respect. But the fog, which can be seen, gives the most 
perfect development of the places in a valley which will be 
most subject to this disease. When it rises from a river in a 
calm morning, it may be seen to spread equally over the valley, 
arising in an equal cloud to the tops of the hills. The slightest 
movement of the air will drive it all over the hill, but it will not 
pass over in its thickness, but like smoke, pass in a thin stream 
over the hill. Admitting that this fog fills the air containing 
the malaria, is it not obvious that the brow of the hill is the 
part most exposed to its influence ? For at this point it all 
passes near the earth's surface, and in my opinion affords a good 
exemplification of the reason, the hill top is the most unhealthy 
location. 

3. Heat and cold, wet and dry. Heat and moisture are essen- 
tial ingredients in the cause of fever. It has been said that bil- 
ious or intermittent fever, will never occur unless the ther- 
mometer, in the shade, will show sixty-five degrees of heat, in 
the day time. My observations on this head, are not experi- 
mental. [ feel authorised to say, that I have never seen the 
disease occur, unless the heat had previously been at least ten 
degrees above sixty-five; and that with the heat, and all other 
causes favoring its production, a considerable time is neces- 
sary to produce it. In years which produce the most violent 
disease, I have observed the mildest cases earlier in the sea- 
son. When every year produced a fatal epidemic fever in 
Milledgeville, the middle of June commonly presented nume- 
rous cases; since 1826, the date of their first appearance 
has gradually receded, till they are hardly seen before 
the month of August. The heat of our summers is always 
sufficient to produce the disease, when other causes concur. 

Moisture seems to be the true point at which the process, 
whatever it is, goes on. Inundations and drenching rains sus- 
pend or destroy it. This I have witnessed, in so many in- 
stances, and under such various circumstances, that I think 
there can be scarcely a doubt of its truth. When in July, 
1810, the month of June presented many cases of fever, 
drenching rains and a freshet in the river, suspended them for 
a month or more; but the dry season which followed, was 
attended with many fatal cases. It was remarkable that 
year that the disease, when it re-appeared, seemed to come sud- 
denly, and in its greatest violence. A family of some forty 
persons, black and white, resided near the river, Ave miles be- 
low Milledgeville. The Indian corn, at the freshet about the 



BILIOUS REMITTING FEVER. 75 

middle of June, was in bloom; and when the water subsided, 
fell down and decayed with great stench. A second planting 
was made, and during its tillage, and till it was in silk and 
tassel, the laborers and the family were in good health. In 
September, two or three of this family were attacked. On 
the morning of the third da} r , these cases appeared alarming, 
and a messenger^was dispatched for medical aid. The mes- 
senger was struck down on the road, and a second was dis- 
patched, who past the first, but did not reach his journey's 
end, till he also was compelled to descend from his horse, and 
rest under the friendly shade of a tree. A traveller passing 
the road, saw the two messengers, and brought the intelligence 
to me. I immediately went to this scene of distress. There 
were only three persons out of the whole of this family, able 
to render any aid to the sick. I considered myself fortunate, 
that from vigorous measures in removing the whole of these 
people to a healthy location, and procuring for them such aid 
as they absolutely required, I was able to say only two died 
of their diseases. 

I have seen it stated, that the extreme of drought, was as 
apt to produce this disease, as any thing else. This never 
occurs, except in the immediate neighborhood of ponds, or 
rivers, or other places, which are at other times covered or 
saturated with water. While the violent endemic, a few years 
past, was desolating the city of Augusta, an eccentric man was 
sowing turnips in the bed of the river, on land on which the sun 
had never before shone within the memory of man. The Eng- 
lish army when in Spain, pitched their tents near some pools 
of water, in the bed of a river which was nearly dried up. — 
They found in the malaria, a more dreadful enemy than the 
French. In every instance in which I have investigated this 
subject, I have found cause to believe, that a state of moisture, 
and not of wetness or dryness, was necessary to give rise to 
bilious fever. The effect is greatest, when all circumstances 
conspire to favor the most rapid putrefaction. But I am not 
prepared to say, that putrefaction is the cause. I have never 
seen the disease arise from the decay of animal matter, how- 
ever offensive. 

4. Decaying subtance». Animal substances or animalised mat- 
ters, such as are found in privies, stables, and yards, have 
never, within my observation, produced bilious fever. The 
scavenger may remove from cities, the cause of dysentery, 
cholera morbus, and possibly typhus fever ; but he is com- 
paratively useless, in removing the cause of bilious fever. — 



76 BILIOUS REMITTING FEVER. 

Let the suspected place be dried or submerged in water, and 
what human art can do is accomplished. 

It does not now occur to me, that I have ever seen it sta- 
ted, that the putrefaction of the flesh of animals has produced 
bilious fever, in any of its forms or varieties. I have stated that 
the decay of the litter of stables, or other similar matter is 
equally harmless. The testimony is different in regard to 
vegetable matters. Grains, fruits, vegetables, and roots, gath- 
ered for consumption, but suffered to decay, have in thou- 
sands of instances been thought to produce this fever. The 
danger is greatest when the decay is most rapid. I once met 
an alarming fever, on a place which I supposed from its loca- 
tion, would be exempt from the malady. On making search, 
I[found near by, four or five bushels of potatoes in the last stage 
of putrefaction. In 1840, I was in the city of New York, in 
the month of August. Passing near one of the slips on the 
East river, I observed in the transparent water, a large quanti- 
ty of potatoes, not less than one hundred bushels. They had 
undoubtedly become too unsound for sale, and been thrown 
overboard, in such a situation as to be exposed to the air and 
the sun at low tide. When I saw them, they were covered in 
water, but the escape of gas from them, equalled the most ac- 
tive fermentation. Apprehending ill from this state of things, 
I continued to notice the newspapers, and soon after observed 
that a fever had broken out near the spot I have been describ- 
ing. In the year 1819, I was in the city of Baltimore in the 
month of July. Passing near Fell's point, I observed a new 
wharf erected, which was being filled up with shavings and 
mud, raised by a machine from the bottom of the basin near the 
wharf. This compost was raised several feet above the tide. 
A fatal bilious, or as it was called in the newspapers, yellow 
fever, soon arose near this spot, and spread consternation 
through the city. 

But it is comparatively seldom, that bilious fever can be 
traced to causes thus obvious. The decay of vegetables, 
grains, seeds, or fruits, gathered by men, seldom cause bilious 
fever. Trees also decay and fall in any number; and when 
other causes do not concur, no fever will arise. When large 
trees are cut around near the root, and die after having put 
forth their leaves, the sap sometimes descends, forming a kind 
°f J e %» which decays with great stench. I have once remain- 
ed, during the summer months, very near hundreds of pines in 
this state. Not the slightest sickness occurred to myself, or 
any one of the numerous family, equally exposed. 



BILIOUS REMITTING FEVER. 77 

5. Is putrefaction the cause of fever? I have said that fever 
does not arise as soon as putrefaction commences, but after a 
considerable time has elapsed. I have never been able to de- 
tect the cause of fever, by the presence of any unpleasant smell 
in the atmosphere. The gases, discharged by putrefaction, 
have long disappeared before fever occurs. Nothing could ex- 
cel the calm, serene beauty of the heavens, and the refreshing 
cool and sweet atmosphere, which I have often breathed in 
Milledgeville, in the month of October, when the w T atch light in 
every house, and the anxious face of almost every one I met, 
announced the presence of an awful pestilence. The senses 
give no intimation of the presence of this fatal pest. A friend 
of mine who resided in Savannah in 1820, when fever was a 
pestilence there , has made to me the same remark. When 
the cool nights of autumn came on, the citizens who had re- 
mained during the season, began to suffer less, and the cause 
of disease seemed to be giving way; but woe to him, who 
from healthier places, ventured to expose himself to this de- 
ceitful scourge, at such a time. A single night, in a place thus 
circumstanced, has been fatal to many. There is no safety, 
till the thermometer has been below the freezing point. Frost 
must have killed the vegetation and blackened the land. How 
long this undiscovered substance, the cause of fever, may remain 
in the place it has originated, under a state of the atmosphere 
too cool to produce it, cannot be told. It disappears suddenly 
before frost, and w T ith equal suddenness, leaves a land over- 
flown with water. But if the atmosphere becomes cool, but 
without frost, there is reason to believe that many weeks will 
elapse before there will be safety for the visitor of these infect- 
ed places. 

6. Water. I think there is no where, a civilized people, who 
drink so little, besides the water of their wells and springs, as 
the citizens of the Southern States. With our ancestors, the 
excitement of wine and distilled liquors, was a fashion; and 
while it heightened the zest of their social intercourse, it pro- 
duced ills not to be contemplated without dismay. This fash- 
ion has now become a matter of history — it has passed away. 
It has given way to a climate unsuited to intemperance, and 
cannot be again revived. This I am sensible will be disbe- 
lieved by many who think that the reform in regard to tem- 
perance, has been brought about by moral causes. These it 
is true, are the noblest foundations of temperance, but our 
case would be bad, if these alone could save us from this de- 
grading vice. 



78 BILIOUS REMITTING FEVER. 

I love the Southern Atlantic States. 1 look upon them as 
the chosen seat, of the highest physical and mental develop- 
ments of man. I therefore have seen, with unspeakable satis- 
faction, the steady progress of the cause of temperance, for the 
last thirty years. The people of this region are physically in- 
capable of using ardent spirits, as a beverage. JNor are the} r 
much more capable of using fermented liquors of any kind. 
If the fountains of their hills flowed with porter and wine, a few 
persons might become sots; but neither wine nor porter, would 
become the common beverage of the country. Intoxication is, 
with man}- of these people, a fearful temporary insanity-. They 
can no more sink down in quiet stupefaction, from strong 
drink, like the Russian, than they can eat ten pounds of whale 
blubber at a meal, like the Greenlander. The Southern men 
who become occasionally intoxicated, commit more acts of out- 
rage and violence, than a thousand times their number of so- 
ber men. The number who give way to this vice is small; 
but the crimes they commit are so fearful and frequent, that 
persons at a distance regard the country as a scene of anarchy 
and bloodshed. Rejoicing that these scenes are becoming less 
frequent, and having full confidence that persons born and 
raised in this climate, have irresistable tendencies towards 
temperance in drink, I leturn to the consideration of the ef- 
fect of the water drank by these people, on their health. 

Water which falls in rain on the earth, is in a tolerable state 
of purity; but by the time it finds its way into springs and 
wells, it becomes more or less mineralized. In the primitive 
region, which lies above the great falls of the rivers at Colum- 
bus, Milledgeville, and Augusta, the water is sufficiently pure 
for drink. That which is most disagreeable to the taste may 
still be drank with safety. But as we get into the rotten lime- 
stone, the scene changes. The first pine hills, resting on mica 
slate and other primitive rocks, yield water in the highest de- 
gree pure and salubrious. Immediately below, the water is to 
be regarded with distrust. That which is found in wells, be- 
ing in fact, rain water, which has passed through an alluvium 
of cla}^ and sand, is not unwholesome. But the springs from 
deeper veins, are less to be depended on. Many of these., aris- 
ing in whitish clay, yield water of a whitish or milky appear- 
ance. In other cases the water is perfectly transparent, and as 
the lime stone region sets in, the water becomes decidedly 
clear. The extensive region to which I now have reference, 
stretches across the country, from ten to fifty miles below Mil- 
ledgeville. Many parts of "it are free from bilious fever, and in 



BILIOUS REMITTING FEVER. 79 

some, the health of the inhabitants seems to be good. But I 
can hardly be deceived, in the opinion, that they are far more 
subject to diseases of the liver, spleen and intestines, than those 
persons, who reside higher up the country. This difference, 
I attribute to the water they drink. This conclusion has not 
been hastily adopted. I have often visited this region, and 
have met the pale face, the tumid spleen, torpid liver, and 
disordered bowels, as far and wide as the springs and wells 
afforded the evidences of bad water I have referred to. Not 
so of bilious fever. This does not extend far beyond the val- 
ley or hills, combining the circumstances above described. 

FORMER MODE OF TREATMENT. 

A great improvement has taken place in the mode of treating 
bilious fever. I propose to give some account of this improve- 
ment, so far as I have witnessed it. When bilious fever first 
appeared in jMilledgeville, the writings of Doctor Rush were 
considered the highest authority on this subject. His remedies 
were familiarly known to every physician, and to a greater or 
less extent, adopted by every one. These remedies were prin- 
cipally bloodletting, and cathartics of calomel and jalap. In 
addition to these, some were in the habit of using James' pow- 
der, tartar emetic, and various compounds, thought to be sudo- 
rific, and febrifuge. Doctor Rush had denounced laudanum and 
Peruvian bark, and thus almost deprived the sick, of two in- 
valuable remedies in this disease. But the influence of a pow- 
erful name was soon overcome, and better means of treatment 
resorted to. Opium and bark were called back into service ; 
but, at first, used with too little discrimination. An English phy- 
sician who had practiced medicine in the West Indies, intro- 
duced into Jefferson county, the practice of inducing a speedy 
salivation, by giving small doses of calomel, and rubbing the 
surface with strong mercurial ointment. This practice, with 
extensive blistering, was adopted in Milledgeville. A speedy 
salivation was soon regarded as the great remedy. I can never 
forget the blue integuments of those I painted with a painter's 
brush, dipped in mercurial ointment. My preceptor seemed to 
delight in the remedy, as much as I disliked the employment of 
laying it on. Each patient recovered in a state of salivation; 
and those who died were thought to have perished, because 
they could not be brought under this potent remedy. Such 
was the treatment of bilious fever in Milledgeville, till about 
the year 1813. The indiscriminate use of mercury to produce 



SO BILIOUS REMITTING FEVER. 

salivation was now reformed. Gradually, each case became a 
special study. Doctor Rush's great maxim of prescribing for 
the symptoms, and not for the name of a disease, was restored 
to its place. He had sadly violated it himself, in Philadelphia; 
but we restored it in Milledgeville. We found that "bark, wine 
and laudanum" were not the poisons they had been thought; 
and the separation of quinine from the bark, has gone far to 
make our remedies for bilious fever, the most valuable and cer- 
tain, in our possession. I meet with no disease in which I use 
remedies with greater confidence. The improvements which 
we made in the treatment of bilious fever, previous to the year 
1829, were pointed out by me, in a lecture, delivered at the re- 
quest of a medical society in Milledgeville, in the month of De- 
cember, of that year. This lecture, written out at the request 
of the society-— has not been published, but is now before me. 
It contains almost all I design saying, in relation to the symp- 
toms, and treatment of bilious fever. 

I cannot omit the opportunity of mentioning the names of 
my able coadjutors in this improvement in the treatment of bil- 
ious fever. Doctors Charles Williamson and Samuel Boykin, 
are entitled to great credit for the skill and energy, with which 
they aided in this great improvement. My intercourse with 
them was always agreeable — always instructive. 

HOW TO AVOID BILIOUS FEVER. 

The cause of bilious fever, may in many instances, be avoid- 
ed, and health and life preserved, by persons who live near it. 
This cause is met in the open air, on the road, in the field, or in 
the woods, and even in houses, located too near the place it is 
produced in. The means of avoiding it, will vary with the 
circumstances under which individuals are placed- Experi- 
ence has shown, that those most exposed to the open air at 
night, are soonest and worst affected. To sleep in the open air 
when the malaria is present, is the worst sort of exposure. To 
visit infected places at night, is dangerous; but I have never 
known a case of fever, brought on by visiting an unhealthy 
place in the day time, and retiring before night. Great advan- 
tage would be derived from entering and closing the house, 
and remaining thus secluded till the next day. Striking exam- 
ples of this, are related by authors; but 1 never found it prac- 
ticable to induce people to conform to this rule. A single 
night spent in an infected atmosphece, will produce the disease, 
in as violent a form as a longer time. Persons in towns, or on 



BILIOUS REMITTING FEVER. 81 

plantations, should recollect, that the cause of this fever arises 
in the nearest marsh, or some such place. Every foot they 
can retire from it, is an advantage. The width of a street, I 
have often found, a matter of consequence. My residence, in 
Milledgeville, was chosen with the light of experience on this 
subject. My family, averaging more than a dozen persons, 
have for twenty years, entirely escaped. Not even the mild- 
est intermittent has happened amongst them. Every year of 
the time, has presented this disease, of some grade, within a 
quarter of a mile. One year, it was formidable, in every house 
south of me; and in the nearest, within forty yards, several 
violent cases, one of which proved fatal, occurred. The first 
object, then, is to keep at a proper distance. A mile and a 
half is probably sufficient. There are few spots in this coun- 
try, in which a healthy residence, within this distance, may 
not be found. Very soon after the settlement of Milledgeville, 
several families found safety in country residences, judiciously 
chosen, from two to four miles distant. These citizens main- 
tained daily intercourse with the town, when it was most un- 
healthy; and returned to it in the winter, and there never oc- 
curred a single instance of fever, chargeable to the these daily 
visits. Persons who travel in summer, should bear in mind, 
the danger of a single night's exposure to unwholesome air. 
The journey should be so arranged, that night may not over- 
take the traveller at unhealthy places. The mariner has with- 
in his reach the same means of escape. He may go on shore 
in the day time, in safety, and in equal security, traverse ev- 
ery sea and visit every clime; but woe to him, if the tempta- 
tions of sea-port towns, or sickly shores, allure him to re- 
main on land at night. Thousands have perished from this 
cause. This danger has been pointed out by medical men, 
and is now generally understood. A rigid rule of staying on 
board, and at night, and keeping at a safe distance from land, is 
the means of preserving the health and the lives of thousands 
every year. 

DESCRIPTION AND TREATMENT OF BILIOUS FEVER. 

Mild form. The reader will recollect that I am here treat- 
ing of bilious fever, as distinguished from common ague and 
fever, and yellow fever. The line of distinction will not be 
very clear ; but in a matter so complex I think this division 
will be useful. 

The mild form of bilious fever has a close relation to inter- 
6 



S2 BILIOUS REMITTING FEVER. 

mitten t, or ague and fever. Both are ushered in with chills, 
and each has a recurrence of these chills at regular times; but 
the intermittent goes offentirel}', leaving the patient, between 
the parox}^sms, in apparent health; while the bilious fever goes 
off less perfectly, leaving the subject of it with some degree of 
fever, till the next chill comes on. The symptoms of various 
cases differ so widely, and yet run into each other, so imper- 
ceptibly, that I have thought it best to describe the numerous 
varieties, and point out their particular remedies, separately. 
This, although tedious, will I think be most perspicuous. 

Bilious fever is a disease of paroxysms and remissions; that 
is, it is according to its grade, violent at one time; but, in less 
than a day, declines again to a much lower state. This fact is 
to be held in strict remembrance ; for there is not, so far as I 
know, a single symptom besides, which is found in every case. 
There is one more circumstance equally uniform. It is a dis- 
ease of summer and autumn, never occurring in winter, or early 
spring. A fever therefore without remissions, or except in re- 
lapses, occurring in winter or spring, may be safely pronounc- 
ed not to be of the malarious or bilious kind. Authors agree 
that the disease is commonly preceded by languor, heaviness, 
want of appetite, giddiness, headache and other symptoms of 
disorder. My own observation does not fully corroborate 
this. When a family is exposed to the cause of bilious fever, 
the most healthy is fully as apt to be the first, and perhaps the 
worst, sufferer, as any other. No preceding symptoms point 
out the individual, who is to be attacked — his spirits will not 
flag, or his appetite fail; and a hearty meal is many times taken 
immediately before the attack. This has been my own ex- 
perience, and I have witnessed the same, in hundreds of other 
cases. Yet, in this changeable disorder, there will be found 
many who seem to be attacked in a mild way, with light pre- 
monitory disorder. 

The type of the milder forms of bilious fever, is what au- 
thors have called a double tertian — a fever with a high parox- 
ysm on one day, and a lighter one on the next — the two days 
constituting in fact one full term of the disease. 

The attack comes on with chilliness and prostration of 
strength, which causes the patient to seek for rest. It usually 
occurs in the evening, does not last long, and is followed by a 
low fever, which continues till late at night. The fever is at- 
tended with headache, and pain in the back and limbs, but with 
so little restlessness as to excite little attention. The patient 
rises in the morning considering himself well. His head how- 






BILIOUS REMITTING FEVER. 83 

ever feels confused, and his tongue is foul and stiff. On ex- 
amination of this organ, it appears covered with an adhering 
whitish coat, which cannot be removed by the brush. It ap- 
pears tumid, and I have seen it so enlarged, in a day or two, as 
to fill the mouth, and show around its edges impressions from 
the teeth. In the mildest form of bilious fever, there is little 
change in the appearance of the tongue, during its whole 
course. 

The second day is passed with very little change, till eve- 
ning or perhaps night. A fever, probably without any chill, 
now comes on. This fever, which is, in my opinion, the be- 
ginning of the second paroxism, which is to put on such vio- 
lence the next day, is very different from that of the preced- 
ing evening. The anxiety and restlessness which occur on 
this second night are marked — the patient complains of thirst, 
but drinks little, is in some distress, but often unable to assign 
a reason, or point to a pain. Towards day these symptoms 
subside, and he seems better, and thus terminates the se- 
cond day. 

The third day has now arrived. Recollect that it is not yet 
forty-eight hours since the attack of the disease ; but writers 
concur in calling this the third day, and so carrying out the cal- 
culation as to call this a third day fever, though it runs through 
its full term once in two days. I shall not attempt to correct 
this error, but go on with my account of the third day. 

A chill in the forenoon ushers in the paroxysm of this day. 
A sharp attack of fever follows, and now, perhaps for the first 
time the patient considers himself really sick. Very fre- 
quently this will be regarded as the first attack of the disease. 
The symptoms will now put on as great violence, as at any 
future time. The chill will be brief, and a violent fever fol- 
low. Great is the variety of the symptoms in various cases. 
Nausea and vomiting may be expected in the chill. Some- 
times they continue through the paroxysm, but frequently not. 
Violent pains in the head, back and loins, and sometimes in 
the limbs occur, with considerable thirst. The pulse is full 
and strong, but not very rapid, and the skin is very hot. The 
complexion is sometimes florid, and the skin bathed in perspi- 
ration, during the hottest part of the fever. In other cases, the 
lips are pale with dry skin, and still greater and more oppres- 
sive heat. This paroxysm usually lasts from ten o'clock in 
the forenoon, till about the same hour at night, being longer 
or shorter, as the disease is worse or milder. It terminates 
with copious perspiration, but calm and quiet, the patient rest- 



84 BILIOUS REMITTING FEVER. 

ing as from the greatest fatigue. Thus terminates the second 
paroxosm, on the third day of the disease, about two days and 
six hours from the first attack. 

The fourth day is passed with the same symptoms as the 
second — a light fever with no leading s}^mptoms. Evening 
ushers in the next paroxysm. The attack is without chill, and 
the fever is slight, with cool extremeties and heat about the 
abdomen and breast. Gradually the pulse becomes hurried, 
but not strong — the face is pale — the breathing deep — some- 
times with sighing— delirium may make its appearance, but this 
is rare. The restlessness increases to a fearful extent, and this 
is a night of indescribable misery, though unattended with 
acute pain. I have had two severe attacks of this disease, 
and can never forget the misery of these nights of low fever. 
They occur on the nights of the fourth, sixth, and other alter- 
nate days. The fourth night presents these symptoms in their 
strongest form. The paroxysm of the next day seems to de- 
pend on the agony of this night — it will be worse in propor- 
tion to these symptoms. 

The fifth day has now arrived. The disease has now acquir- 
ed its full foice, and death may happen in the course of the 
night. But the case we are considering is commonly borne 
through successfully. The symptoms of the fifth day, if the 
disease has received no check from remedies, are the same 
with those of the third. The chill is less, and the fever is 
higher, and continues longer. The strength of the patient 
gives way, and he has more delirium. As the fever subsides, 
a great paleness of the face is observed. The features do not 
shrink as in typhus, but remain full and plump even to death, 
should it occur. Throughout the paroxysm the patient seems 
to be put to the severest trial, and as the fever subsides, he 
seems to be relieved as if from the greatest effort — he runs in- 
to a profuse perspiration, and sinks into sleep as if fatigued to 
the last degree. If the case is mild, and it is such we are 
now considering, the sleep of the patient is refreshing, and on 
the morning of the sixth day, all the symptoms are improved, 
and there is only a slight appearance of fever yet remaining. 

The sixth day may be compared to the fourth. If no fatal 
injury has happened on the fifth, the case will go on with lit- 
tle change worthy of remark. The low paroxysm at night, 
will not fail to produce its accustomed effect ; and if the dis- 
ease is not checked by treatment, the night will probably be 
worse than any which has preceded it. 

The seventh day is the grand climax of this grade of fever. 



BILIOUS REMITTING FEVER. 85 

The symptoms of the fifth day wiil again present themselves, 
and the strength of the patient will be less. If there is dan- 
ger, look out for it now. If nature is overtaxed, she will now 
be ready to sink under the burthen. Profuse perspiration, 
with copious discharges by the bowels, or by vomiting, may 
prostrate the patient beyond recovery. The heat of the body 
will remain, but the forehead will be cold and moist — the ex- 
tremities pale or livid. Hiccup and laborious respiration de- 
note approaching dissolution. The mind, in this solemn hour, 
is wonderfully tranquil, frequently retaining its powers, till the 
pulse can no longer be felt at the wrist. In other cases it gives 
way, the ideas become incoherent, and a muttering delirium or 
boistrous screams, increase the horrors of the scene. But the 
seventh day does not always terminate the case, and the pa- 
roxysm terminates without running into the extremity we have 
been contemplating. Frequently the profuse perspiration, and 
cooling down of the fever, are its regular termination, and the 
patient is restored to health. More frequently the fever but 
subsides, to make another assault on the ninth day. 

The eighth day is one of comparative tranquility. The ex- 
hausted patient seems not to have rested sufficiently on the 
night of the seventh, and slumbers through the forenoon of 
the eighth. The evening presents the expected rise* of the 
fever, and the night its accustomed distress. Sometimes this 
night is especially memorable, producing all the distress we 
have described in the most aggravated form. 

GO 

The ninth day is also a great crisis. If the case has not ter- 
minated on the fifth or the seventh, the symptoms of the ninth 
ma}' be expected to be similar to those of the seventh day ; but 
commonly they will be in a mitigated form. If proper remedies 
have been used, a crisis on the ninth day will be almost uniform- 
ly a restoration to health. But if the disease is allowedto take 
its own course, the ninth day will be a day of peril. It was so 
regarded by the ancients, who knew no remedies of much val- 
ue, or lacked the skill to use them properly, in this disease. 

The tenth day is a day of light fever, if indeed the case has 
lasted so long. Great exhaustion is of course present, and a 
dozy listlessness is felt in the forenoon. The night of this day 
may have its horrors still, and the next day its dangers too. 
This ought not to occur. It will not occur where the treat- 
ment is skilful. Before the discovery of quinine, this late ap- 
pearance of danger was common. With this invaluable reme- 
dy in our hands, a bilious fever of the regular kind, I have de- 
scribed, will not continue eleven days. 



86 BILIOUS REMITTING FEVER. 

The eleventh day is a day of paroxysm, and may be one of 
danger. No new symptoms will be likely to occur, and the 
case may be expected to terminate favorably on the night of 
this day. 

Should the fever continue longer than the eleventh day, its 
periods cannot be reckoned on with any certainty. Sometimes 
it now becomes a regular intermittent ; but more frequently it 
runs an irregular course to the end. The fourteenth, seven- 
teenth and twentieth days, have been regarded as critical, or 
days of its probable termination. I have not been able to per- 
ceive the truth of this statement. It may be true in cases al- 
lowed to run on without the control of remedies. 

Such are the symptoms and progress of the most common 
form of bilious fever, as I have met with it for the last thirty 
years. Such cases will commonly terminate favorably under 
almost any system of treatment. But I have not attempted to 
enumerate all the symptoms which may present themselves, 
even in mild cases. The task would be as difficult as it would 
be useless. I think I have said enough to make it easy to re- 
cognize the disease. I shall attempt to describe such other 
forms as I think require a peculiar treatment, and leave it to 
the judgement of the practitioner, to vary his remedies to suit 
particular cases. 

TREATMENT OF MILD CASES OF BILIOUS FEVER. 

I have stated that the milder forms of this disease will ter- 
minate favorably, under almost any mode of treatment. I am 
far, however, from thinking that modes of treatment are indif- 
ferent. A recovery under a feeble or pernicious treatment, 
differs widely from one effected by proper remedies. The 
one is but an escepe from death — the other a restoration to 
health. 

We have two great remedies for bilious fever — mercury — 
especially calomel, and peruvian bark, or rather quinine ob- 
tained from it. These remedies have in my opinion curative 
powers, especially suited to this disease. No one should pre- 
tend to treat a single case without them. But we have other 
important remedies, which I shall endeavor to assign to their 
proper places. 

First day. It is seldom that a remedy is sought by patients 
on the first day of fever. In this case in particular, the at- 
tack is commonly late in the day, and the symptoms slight ; 
and it would seldom be practicable at this period to tell the 



BILIOUS REMITTING FEVER. 87 

nature of the disease. Yet a mild attack of fever in the eve- 
ning, at a time and place rendering it probable that it is a bil- 
ious fever, should be promptly met with a dose of calomel. 
A medium dose, ten grains in this climate, may be given in 
pills or a little syrup. Should it fail to operate by morning, a 
seidlitz powder may be taken. 

Second day. This is a day of uncertainty, for no one can tell 
that to-morrow will bring on a regular attack of fever. But 
governed by the same rule of prudence, the case may be treat- 
ed as bilious fever. If there is a considerable remission, and 
it can hardly fail in mild bilious fever, quinine should be ad- 
ministered. Ten grains given in four doses, one hourly from 
seven to ten o'clock in the forenoon. If the fever has not in- 
creased considerably, give ten grains of Dover's powder or 
thirty drops of laudanum with the last dose. This concludes 
the treatment of the second day. 

Third day. A chill in the forenoon, followed by high fever, 
is the common course of the disease on the third day. In the 
practice, this is indeed almost always the first day a prescrip- 
tion is given. The disease now puts on its serious aspect. 
The chill stage is very short, and I do not advise any remedy 
in it. The patient should avoid excess in drinking, as water 
thus taken is speedily rejected, and I think 1 have seen cases 
verv much aggravated by this indulgence. Excessive cover- 
ing is useless, and I think warm applications equally so. Yet 
I would not object to warm brick, or warm clothing, while the 
sensations of the patient seemed to demand them. 

The rise of the fever should be met with a prompt remedy. 
If the pulse is high or the heat considerable, or if from great 
sickness at the stomach, the pulse is rapid and contracted, and 
there is no great discharge from the stomach when the patient 
throws up, the use of antimoniai medicines will be proper. 
Take of tartar emetic two grains, nitrate of potash two 
drachms, and dissolve them in half a pint of water. Give a 
table spoonful every half hour, till it proves emetic. If from 
debility of the patient, or a knowledge of excessive suscepti- 
bility to the action of this or other remedies, it is deemed im- 
prudent to press this, the dose may be lessened and the time 
extended according to the circumstances of the case. In cases 
of great debility or early childhood, I have substituted ipecac 
for the tartar emetic. Take two drachms of nitre and thirty 
grains of ipecac — mix them in half a pint of cold water, and 
give a table spoonful every fifteen minutes, till it proves emetic. 
This is greatly inferior to the the above, and only to be used 



88 BILIOUS REMITTING FEVER. 

where a milder action is deemed prudent. These remedies 
are to be given in proportion to the violence of the symptoms. 
If the emetic operates promptly, and the fever continues with- 
out abatement, doses of the mixture may be given once in an 
hour or two, till the fever subsides. The sickness at the stom- 
ach induced by this coarse, tends powerfully to lessen the fe- 
ver; indeed the anlimonial mixture surpasses all other reme- 
dies for this purpose, and should be given with constant atten- 
tion to the heat of the body and violence of the circulation. 
Used in this manner, these remedies become cathartic, and as 
soon as they operate in this way, they are to be laid aside for 
the day. If two or three copious discharges from the bowels 
are thus brought on, forty to sixty drops of laudanum may be 
given, and if necessary to stop these operations, the laudanum 
may in smaller doses be repeated from time to time. Tartar 
emetic and nitre, is our great means of lessening the violence 
of this fever. A great majority of cases admit of its use, and 
I have experienced the great relief it affords, in allaying thirst, 
relieveing pain, removing restlessness and promoting perspira- 
tion. It is only when it operates as a cathartic that it cannot 
be profitably continued. 

Here let me guard the practitioner against excess in the use 
of the valuable remedy, cathartics. No mistake has been 
more pernicious than that which has taught us to believe that 
cathartics were beneficial, as long as bilious discharges were 
brought on. On the contrary, I think these remedies when 
used to exhaust the fluids, check perspiration, debilitate the 
patient and disorder the bowels, are exceedingly pernicious, 
even in bilious fever. No remedy is more likely to do harm in 
this way, than tartar emetic given for a great length of time in 
small doses. This is more particularly so at the approach of 
winter, and I have in more than one season, found it necessa- 
ry to abandon the use of tartar emetic entirely, as the cool 
nights of autumn came on. The danger of using tartar emetic 
in this way, is fully met by its powerful antagonist, opium or 
laudanum. Given as directed above, it not only controls ef- 
fectually tartar emetic, but conveits it into a valuable auxiliary 
to itself, in closing the paroxysm with a generous and profuse 
perspiration. No remedy I have ever used in medicine, has 
given me more satisfaction than laudanum, given towards the 
close of the paroxysms of bilious fever. Given after tartar 
emetic as above advised, its action is as agreeable as it is 
beneficial. But its use is not restricted to these cases. The 
rule is general to give laudanum near the close of a parox- 



BILIOUS REMITTING FEVER. 89 

ysm of bilious fever. Give it in full closes, and let them be 
larger, where from the great activity of remedies, or exhaustion 
from protracted suffering, the patient requires a soothing ano- 
dyne. If the medicines taken have operated slightly, and the 
patient is not much exhausted, the laudanum will be unneces- 
sary. 

I have but little to add in regard to remedies for the third 
day of fever. I ought not to omit cold applications, and cold 
drinks. The obvious effect of these remedies, in lessening the 
heat of fever, and the great addition they make to the comfort 
of the patient, commend them to the regard of the practitioner. 
There are states of the stomach, where from great irritation, 
water is no sooner swallowed than rejected. This is frequent 
in the chill stage, but sometimes continues through the parox- 
ysm. This state of the stomach does not occur in the low 
grade of fever we are now considering, and will be treated of 
elsewhere. If the heat of the body is considerable, and the 
patient feels it to be oppressive, let a towel be dipped in cold 
water, not ice water, and rubbed over the face, arms and legs, 
till fully wet. Let these parts remain exposed under a brisk 
current of air, by fanning, and when the parts begin to dry, 
re-apply the water. This course vigorously pursued, will, in a 
few minutes, reduce the heat and moderate the circulation in a 
wonderful degree; it may be pursued under the judgement of 
the practitioner. The sensations of the patient cannot always 
be relied on, yet in moderate cases of fever they are seldom 
wrong. Cold drinks, such as iced water or lemonade, are to 
be indulged in under proper regulations. They are in general 
proper, to the extent demanded by the patient ; but should the 
medicines used operate actively, it will be a good reason for 
suspending cold drinks for a time. Indeed a warm cup of tea 
may be advantageously taken at such a time. 

Fourth day. This day ought to bring to a close an ordinary 
attack of bilious fever ; but this cannot happen unless reme- 
dies have been vigorously used. The natural course of the 
disease is a continuance of from nine days, to three weeks. If 
our treatment has been any way successful, there will be a re- 
mission on the fourth day almost amounting to a perfect inter- 
val. This remission, be it more or less perfect, is the time to 
administer quinine. This is the great, and I believe now uni- 
versally accepted specific, for all the forms of bilious fever. It 
is now administered with but little regard to circumstances. 
My own opinion is, that it should by no means be administered 
in the rising stage of the paroxysms of fever. From ten to 



90 BILIOUS REMITTING FEVER. 

twenty grains of quinine may be given on the fourth day. Be- 
gin at ten o'clock in the forenoon, and give from two to four 
grains hourly, till the amount designed for the day is taken. 
It may be taken in pills or in solution. If no fever appears by 
six o'clock, give thirty drops of laudanum. My own practice 
is, to make ten grains of quinine into six pills, and give one 
hourly till all are consumed. Any deviation in the manner of 
administering it will be allowable. This quantity will com- 
monly hinder the accession of fever, which would occur but 
for its use, on the evening or night of the fourth day. I have, 
in many instances, given a larger quantity of quinine, and 
should do so now if I apprehended a dangerous fever on the 
next day. I have not adopted the very liberal use, lately 
made of this article. In any manner of using it, a great deal 
of dizziness and. ringing in the ears is caused. None of my 
patients return to me deaf, or with noise or ringing of the ears 
which cannot be gotten rid of. It appears to me wrong to use 
this remedy to such an extent ; and nothing but necessity, and 
a change of my present opinions, will induce me to do it. I 
do not under any circumstances advise the use of more than 
thirty groins of quinine in one day. 

If on the fourth night the patient have restlessness or fever, 
a second dose of calomel should be given. If the patient is 
apt to experience much nausea from this remedy, add to it a 
quarter or a third of a grain of morphine, notwithstanding a 
dose of laudanum may have been given a few hours before. 

Fifth day. If the fever of the fourth day, has been pre- 
vented, and the night passed in quiet sleep ; the morning of the 
fifth day is bright with confident expectation. If the night has 
been one of restlessness and fever, the hope will be less. In 
either event, the quinine is to be repeated in the same quan- 
tity as on the day before. Commence six hours before the ex- 
pected chill, and take the remedy in shorter time so as to finish 
the day's allowance, two or three hours in anticipation of the 
chill. With the last dose, if fever has not come on, give a 
dose of laudanum or Dover's powder. The result is now to 
be awaited in quietness. 

The chill of the fifth day may be expected in the forenoon. 
It will be slight, and perhaps not perceived in the heat and ex- 
citement produced by remedies. The fever will be as high as 
at any other time, and the symptoms discover danger, if the 
case is likely to produce it. If the attack seems violent, recol- 
lect that the patient yet has strength and may bear active reme- 
dies. If he has taken his dose of calomel the previous night, 



BILIOUS REMITTING FEVER. 91 

the tartar emetic and nitre, recommended on the third day, 
will cause a prompt cathartic action on the bowels. This 
forms no objection to the use of the emetic mixture, but sug- 
gests caution against using it too freely or too long. If the dose 
of calomel has not been taken, that remedy is now to be given. 
Remember that this is the fifth day, and that now, if ever, the 
most active remedies are demanded. If the patient is vig- 
orous, give the following powder. Take of calomel thirty 
grains, tartar emetic two grains — nitrate of potash sixty 
grains, — rub together and divide into eight powders. Give 
one of these powders in syrup every two hours, or half of one 
at shorter intervals, if the stomach will bear them better. The 
desire in this case is to produce a cathartic operation, and the 
time between the doses may be extended, if the stomach 
seems to reject the remedy. Several operations as an emetic, 
followed by three or four operations by the bowels, can be 
borne, by vigorous patients at this stage of the disease. This, 
I consider very active treatment, and it should be guarded by 
the use of laudanum if necessary; but at the same time, I re- 
gard this combination of remedies the most efficient I have 
seen tried. The patient who is so managed on the fifth day, 
will probably not have another paroxysm of much violence ; 
and if he recover, he will be free from enlarged spleen, inflam- 
ed liver, and jaundiced complexion. I have seen such recov- 
eries, the most perfect. 

The application of cold water, the use of cold drinks, and 
the administration of a dose of laudanum at the decline of 
the fever, need not be again suggested — they are to be used as 
directed for the third day. 

Sixth day. Every day, is now full of confident expectation, 
the practitioner constantly expecting the paroxysms to cease. 
The sixth day is not a day of fear but of hope. The pre- 
vention of its low paroxysm at night, will ensure the arrest of 
the great and dangerous paroxysm of the next day. The 
morning of the sixth day is therefore to be diligently improved. 
The sole reliance is on quinine. Begin early in the morning, 
with doses of two grains hourly, and proceed through the day 
till from ten to twenty grains are taken. In the evening, give a 
dose of laudanum or Dover's powder. Nothing further will be 
required, unless there is a considerable rise of fever at night. 
In that event, a discretionary use of cold water applied to the 
surface is all I advise. 

Seventh day. A minute examination of the symptoms should 
be made on the morning of the seventh day. If the tongue is 



92 BILIOUS REMITTING FEVER. 

shrunken, and beginning to be sharp at the point ; if it is 
brown at the base and along the centre, and trembles when 
thrust out of the mouth, a great degree of exhaustion has al- 
ready taken place. If on the contrary it retains its fullness, 
looks white, and when attempted to be shown, appears hardly 
pointed at all, but round and tumid, the patient has borne up 
well under his affliction, and may bear the contest though it 
last for days to come. The power and motions of the body 
and limbs, give evidence of the same fact — if they are steady, 
there is much remaining strength, — if trembling, the strength is 
gone. If there are signs of much exhaustion, be carelul to 
use no evacuating remedy. If the patient has any appetite, 
give some light food early in the morning. A cup of tea with 
hominy or rice and butter if desired. This indulgence would 
have been proper in the remissions of fever for two or three 
days past, but now it becomes necessary. 

But the seventh day is a day of paroxysm, and a chill may 
be expected in the forenoon. Begin with quinine six hours be- 
fore the expected chill. Give two grains per hour, or more if 
the S} T mptoms are alarming. Give ten drops of laudanum with 
each dose, and if the patient seems feeble, give a table spoon- 
ful of brandy in w 7 ater, two or three times in the forenoon. 

If the fever comes on, whether preceded by chill or not, do 
not be too hasty in administering medicines. If the heat is 
great, apply cold water as before directed. Observe the pulse, 
and the breathing of the patient. If the application of cold 
reduces its frequency and force, and renders the breathing ea- 
sy and deliberate, it will be proper to suspend it for a time, 
and return to it again, as the symptoms seem to require. If 
delirium conies on, apply cold to the head. Ice water, or 
pounded ice in bladders, may be applied over the hairy scalp. 
Ice is too cold for a safe application to other parts of the body, 
especially where the patient is delirious and unable to direct 
its removal in case of necessity. The antimonial or tartarised 
mixture, recommended in the preceding paroxysms, is now to 
be omitted, or used in diminished doses. If the fever is high 
and face flushed, this remedy may be ventured on, but, in gene- 
ral, the paroxysm of the seventh day is to be treated without 
any evacuating remed}^. In some cases the pulse will be 
strong and the heat of the body very great, and yet the strength 
so exhausted as to forbid the emetic. In this case, give the 
following. Take of nitre one drachm, cream of tartar one ounce, 
rub well together and divide into eight powders. ' Give one of these 
in water, every hour and a half, till four are taken, if the fever 



BILIOUS REMITTING FEVER. 93 

does not give way sooner. When the fever is perceived to be 
on the decline, give thirty drops of laudanum, and enlarge the 
dose, if the case seems alarming. 

As the fever declines on the seventh day, a watchful care 
should be had over the patient. Death is sometimes at the 
door when least expected. A copious discharge from the bow- 
els might prostrate the strength, and put a period to life in a 
few minutes. The dose of laudanum already advised, is the 
best means of preventing this. But should the bowels give 
way, the laudanum should be repeated, and Cogniac brandy 
or other good spirit given freely. If the strength still gives 
way, and the surface grows cold, stimulants which redden the 
skin, such as mustard, cayenne pepper, or spirit of turpentine 
have been extensively tried. I have but little faith in them 
myself, and prefer frequently rubbing off the perspiration, with 
a dry rough towel, and keeping the skin as dry as possible. 
If heat is applied, let it be in a dry way, as bottles of hot wa- 
ter, hot bricks, &c. I am now treating of a case of extremity, 
in which the patient seems to be sinking into the arms of deaths 
Let no one pronounce it hopeless — stand by with the brandy 
and laudanum, and give them together or separate as the case 
may require. The brandy is the purest and best of all stimu- 
lants, and the laudanum a stimulant of value, but of far more 
value to relieve irritation and soothe every nervous distur- 
bance. To what extent shall these remedies be carried ? This 
I will not pretend to state precisely. I have stood by patients 
in this extremity, and given a full quart of brandy in the course 
of one night, without the least appearance of intoxication, and 
with the happiest results. I have given laudanum to the ex- 
tent of twenty drops every half hour for several hours, with the 
same result. These remedies may be given combined or 
separaie. I once witnessed a case which had been visited by 
a physician, who directed a tea spoonfull of laudanum every 
hour. Expecting the case to terminate fatally in a few hours, 
he left the direction without limit, and when I saw the patient 
twelve hours afterwards, he had emptied a two ounce vial of 
laudanum. He was now in a profound sleep from which it 
appeared impossible he should ever be aroused. Yet he did 
awake, and had no more return of fever. 

I deem it unnecessary to detail this mode of treatment furth- 
er. If the disease passes on to the eighth day, it is to be treat- 
ed as the sixth has been — if to the ninth, the same as the sev- 
enth, and should a crisis, fearful as I have described, come on 
earlier or later, let the stimulants be administered as I have 



94 BILIOUS REMITTING FEVER. 

directed. I have said nothing of bile or the remedies relied on 
to expel it from the system. In the cases 1 have been treat- 
ing, the practice is not influenced, by the appearance or non- 
appearance of bile. The same remark may be made of blood- 
letting. I do not advise it, except in extreme cases. 

I have detailed the remedies I use, and the exact times at 
which I use them, with a precision no where else to be found. 
The experienced practitioner may object, that the variety of 
cases is too great, and their periods too various, for the appli- 
plication of such rules. I advise a little hesitation before such 
a decision is pronounced. I describe the disease as 1 have wit- 
nessed it, and have compared its phenomena from year to year. 
A vast majority of the cases I have witnessed, fall readily into 
the account I have given. The occurrence of s3 7 mptoms I 
have not mentioned, should produce no embarrassment, while 
the general course of the disease is such as I have stated. — 
Neither should a variation from the times or periods of the at- 
tack, or a longer or shorter paroxysm. These varieties will 
occur, and it requires but little judgment to adopt the necessa- 
ry measures to each case. The cases here described are in- 
tended to represent, the mass of common cases, and the treat- 
ment is adapted to such cases especially. But there are other 
cases not coming under this account, or allowing the same 
mode of treatment. The most important of these, I shall at- 
tempt to present ; hoping thereby to lessen the danger of some 
of these cases, and to render less intricate, a tangled wilder- 
ness of medical authorities. 

CONGESTIVE FEVER. 

This name, for a variety of bilious fever, has of late had great 
currency ; but with meaning, so uncertain as to render its dis- 
cussion difficult. Doctor Dunglison defines it "a fever ac- 
companied by obscure symptoms ; or by great oppression and 
depression" — he adds that these fevers occur in various parts 
of the country, " especially in the fall; and they are very 
common in India." My attention will, at present, be exclu- 
sively directed to those cases of congestion, which occur in 
autumnal or bilious fevers. Strictly speaking, the term con- 
gestion signifies "the accumulation of blood or other fluid in 
an organ." I use the term in a more extended sense, to signify 
a malignant bilious fever, with obscure symptoms, and characte- 
rised by great "oppression and depression of the system." 

An opinion, that this form of bilious fever is more common 



BILIOUS REMITTING FEVER. 95 

now adays, than formerly, prevails I think, very extensively. 
I am frequently asked by physicians, if I do not think the pre- 
valence of congestive fever at present, an example of the great 
change in elements, so often noticed by writers, and especially 
by Sydenham, as a change in "the constitution of the atmos- 
phere." Others hearing a term so new to them, desire to 
know if congestive fever is a new disease. I think it is not a 
new disease, but an old one, under a new title. The obscurity 
of its symptoms, has caused it to be misunderstood, and mis- 
called a thousand times. Many sudden deaths which have 
occurred from it, have been charged to other diseases. Doc- 
tor Rush, who knew fever only as a state of diseased action, 
and witnessing only the want of action in these cases, invented 
the term " suffocated excitement" to signify their character. — 
This term did not obtain currency, and when I became a prac- 
titioner myself, the term collapse was used to signify the 
same state of the system. It is a malignant form of fever, 
arising from great concentration of malaria in the place it is 
contracted in, and is attended with great danger. I have never 
seen it occur, where the cases of fever were few, or of mild 
character, and have seen years pass without witnessing a sin- 
gle case of it in Milledgeville or its neighborhood. Yet in sick- 
ly seasons in the same place, I have met with many cases in 
a few weeks. 

Congestive fever, like common bilious fever, is a disease of 
paroxysms. This, I am apprised, has been overlooked by 
some ; but I have never seen an exception to it. The dying 
struggle which sometimes continues for days, is no reasonable 
exception to this rule. The disease runs its course, and is a 
remittent, with violent paroxysms every second day, just as 
they have been described in common cases of fever. I have 
never seen the first paroxysm fatal, and have seldom seen the 
symptoms which denote congestion, occur before the third day, 
or second paroxysm. I have not observed that the first attack, 
of this form of fever, was unusually violent, but think I have 
noticed a want of color in the skin, with slow and deep breath- 
ing, and a carelessness, or rather torpid state of the mind. 

The congestive fever is a disease of obscure symptoms, yet 
it is the same as bilious fever, in having paroxysms and remis- 
sions, and a violent and a mild day. But here the parallel 
ceases. The pulse, in congestive fever, is sometimes small, 
and scarcely perceptible; at other times, or rather in other cases, 
tranquil even, and nearly as in health. The skin is cool, es- 
pecially where exposed to the air, and on the extremities. The 



96 BILIOUS REMITTING FEVER. 

nails are purple, and the face pale or mottled. The blood in 
the smaller vessels of the skin, seems to move slowly— the fin- 
ger pressed on it, leaves a white mark, which disappears slow- 
ly on its being removed. The complexion though tawny is not 
bilious, and I have seen the whites of the eyes of a pearly white, 
near to the hour of death. These symptoms denote depression, 
and, according to our experience in other cases, should be fol- 
lowed by great heat and a boundingand full pulse. This does 
not occur. A feverish heat gradually extends to the extremi- 
ties, the breathing becomes easy, and the patient tranquil, but 
the skin does not recover its proper color. The heat of the bo- 
dy does not rise to a great height at any time, but while the ex- 
tremities are cool, an examination will often show great heat 
of the chest and back ; as if the heat too, as well as the blood, 
had accumulated in the great central organs. 

Pain is not always felt in this form of fever, yet it is some- 
times present and very violent. The mind is usually free from 
delirium, and in the remission, marked by a disregard of the 
danger which is obvious to every one. The pain which I have 
witnessed in these cases, has attacked the liver, spleen, stom- 
ach and intestines, being experienced over an extensive region 
with great violence. 

Many years ago I was called to see a mill-wright, who had 
an attack of congestive fever. I saw him on the morning of 
the third day, in the chill, which was very slight. I left him 
under advice, but in an hour was called in haste to see him. — 
He had been suddenly attacked with violent pain in the region 
of the liver, spleen, and intestines. He was writhing in agony ; 
pale, cold, and with a feeble pulse ; he rolled from side to side, 
not drawn like one in colic, but desperate, and ready to swal- 
low any thing which promised ease. I gave him a full dose 
of calomel and laudanum, and advised hot applications. A 
short time brought him ease, and a state of tranquility not to 
have been expected. His calomel operated in the night, and I 
found him the next morning, sitting in a chair reading a news- 
paper. His pulse was rather feeble, and his skin rather taw- 
ny, and mottled, but in other respects I could not have thought 
him very ill. 

The next morning, I made it a point to be present, before the 
hour of his chill. He had spent a bad night, and his chill came 
on at its hour. Shortly he had a renewal of the attack of pain, 
with symptoms more violent than before. His remedy was 
repeated, but with less effect — he became delirious, or rather 
wandered in his thoughts — his pulse gradually sunk, and he 



BILIOUS REMITTING FEVER. 97 

died about nine o'clock at night — twelve hours from the attack 
of the paroxysm. This is an example of congestive fever, as I 
have several times witnessed it. At a later period of the dis- 
ease, I have seen patients run into a state similar to this, with 
less pain, more delirium, and perhaps equal danger. Com- 
monly the case terminated in death, without ever reaching an- 
other paroxysm. 

A great deal more might be said on this form of fever, but I 
fear it would not much improve our knowledge. The disease 
is as obscure as it is dangerous, and the danger is greater than 
the symptoms would seem to warrant. The strength of the 
patient is less reduced than might be expected, his complexion 
is not bilious or of saffron tinge, but tawny, with a blue or 
purplish shade, especially under the ringer nails. This purple 
tinge which extends over the whole surface, is perhaps the 
most certain mark of the existence of this state of fever. The 
stolid, or indifferent state of the mind, I have frequently no- 
ticed, and I think its attacks are principally on grown persons. 

Treatment of Congestive fever. Quinine is now considered 
the sole reliance in congestive fever. It is given, with little 
regard to time or quantity, so that enough is given. Florida, 
Alabama, Mississippi, Texas, and Mexico are now furnishing 
a wide field of experience in the use of this remedy in this 
disease. We are under great obligations to the physicians of 
the army, and others who themselves brave the danger, 
and publish accounts of its management. I think time will 
shew, that some of them have been rather enthusiastic in their 
administration of quinine. When I read in some of their ac- 
counts, that patients struck down with congestive fever, and 
rather dead than alive, have been rescued from the grave by 
the daily use of eighty or an hundred grains of quinine ; or 
perhaps by doses oi forty grains administered, I know not how 
often, and that these recoveries have, after three weeks, ap- 
peared perfect, with the exception of the deafness, which had 
not yet given way, I think the disease might have been as suc- 
cessfully treated with a moderate use of quinine, and the 
deafness and attending nervous symptoms avoided. 

My own course in these cases is to procure, on the day of 
the greatest paroxysm, a free action on the bowels, by calomel 
followed by seidlitz powder or Epsom salts. This is not al- 
ways easily accomplished. The prostration of the system, 
weakness of the pulse, and agony from pain, seem to demand 
the free use of laudanum, and I have been satisfied with its 
effects. I give the calomel and laudanum together, and do not 
7 



98 BILIOUS REMITTING FEVER. 

expect a cathartic effect before the pain subsides, and the fever 
is near its lowest point. 1 have tried the use of cathartics on 
the day of remission, or well day, as it has been called ; but 
have thought the succeeding paroxysm rather worse than bet- 
ter, from their use. The use of calomel and laudanum should 
be repeated every second day, or on the third and fifth days in 
particular, and with this moderate treatment, I am fuilv per- 
suaded, that more success will be had, than with a more active 
course. Doctor Rush bled and gave calomel and jalap ; tar- 
tar emetic in large doses has been tried by others — to some 
extent, I have seen all these measures put in requisition, and 
after witnessing their effect, and comparing results under my 
own method, have come to the conclusion, that all these de- 
bilitating and drastic remedies are hurtful. One or two doses 
of calomel, followed by the mildest purgatives, and combined 
with laudanum according to circumstances, form the whole of 
the active or depleting remedies, I think admissible in this dan- 
gerous disease. 

But these remedies do not hinder the great specific, quinine, 
without which our control of congestive fever would be lost. — 
It is fortunate, that this remedy is proper in this, as well as in 
other forms of bilious fever. I have seen much harm from the 
use of violent cathartics and emetics in this disease, but none 
from quinine. Use it early and freely. As soon as the remis- 
sion happens, commence with quinine, in doses of two grains 
hourly. If it is not administered early, let the dose be enlarged 
to three or four grains. Thirty or forty grains is the most I 
should advise, in two days. Give half this quantity on the day 
after a violent paroxysm, that is, on the day of the remission. 
On the morning of the worst day, commence very early — at 
three or four o'clock, and give hourly doses of three or four 
grains, till fifteen or twenty grains are taken. 

The remedies for congestive fever, are few and easily admin- 
istered ; the difficulty is in knowing the disease, and judging of 
the time at which the remedy should be given. The obscurity 
which attends such cases, arises from the absence of the reac- 
tion which characterises bilious fever. The chill is scarcely 
obvious, and the agony, distress, and pain, which attend it, 
differ so widely from common fever, that physicians often mis- 
take the case entirely. Some attention is to be paid to the 
place and season, at which such attacks occur. If these raise 
a reasonable suspicion, then notice the going off of the chill or 
pain, and agony ; and a fever, though not very high, will be ob- 



BILIOUS REMITTING FEVER. 99 

served. The heat will gradually extend to the extremities, 
and burning heat of feet and hands will be complained of. 

It is still worse, when the symptoms of congestion are not 
noticed till they assume a permanent form, and can only result 
in death. This state often occurs as early as the third, or fifth 
day, and in truth, does not give rise to obvious fever. No ad- 
vantage can here be taken of time or circumstances. Quinine 
and laudanum are here to be given and repeated, from time to 
time. I have added camphor, I think, with great advantage. 
Five grains may be given hourly till twenty or thirty grains are 
given. An experienced physician should, if possible, be pres- 
ent during such cases. 

With Cholera Morbus. This is a frequent and violent form of 
bilious fever. I use the term cholera morbus, to distinguish it 
from spasmodic cholera, as the disease in question is never at- 
tended with spasms. No bilious fever is more regular in its 
course than this — a milder paroxysm at night with nausea — 
a remission of a few hours in the morning — then a chill, with 
vomiting, commonly of bile ; which, after the fever has risen, 
is followed with large bilious discharges by the bowels. The 
paroxysm subsides at night with but little perspiration, and 
the next morning the patient, pale and debilitated, reports him- 
self much better. He now passes the day in ease and com- 
fort, till evening or night, when the light fever and restlessness 
of bilious fever commence again. On the next day the attack 
is renewed, and goes through the same routine with wonderful 
exactness. Such cases are apt to continue for seven or nine 
days, when a crisis occurs, and the patient recovers, or sinks 
to rise no more. This form of fever, is distinguished from 
others attended with sickness at the stomach, by the copious 
discharges of bile from the bowels, during the hot stage. The 
discharges are not frequent, but copious, and the nausea not 
so distressing as in other cases. The restlessness and general 
distress is also less. 

Treatment. This is a dangerous grade of fever, but under 
proper treatment, seldom fatal. Nature should not be thwart- 
ed in her operations too hastily. The copious discharges of 
bile, are curative, and should not be checked too soon. The 
administration of calomel, tartar emetic, and nitre, in combi- 
nation, produces symptoms very nearly resembling those pro- 
duced by the curative powers of nature in the case we are 
considering, and I can truly say, with nearly the same good 
effect. This iorm of fever has been regarded as a strong ex- 
hibition of the powers of nature, in throwing off the matter 



100 BILIOUS REMITTING FEVER. 

which caused the disease. I offer no opinion, but fortified by 
experience, I say, give neither emetic nor cathartic. Let na- 
ture in this case, perform her own work. 

The first remedy in these cases is laudanum or opium. If 
the discharges are copious, and still more, if the stomach and 
bowels are racked with pain, give from sixty to eighty drops 
of laudanum, or three or four grains of opium. These are 
large doses, and suited to a violent disease, but may be lessen- 
ed where the case does not seem very severe. 

The thirst in these cases is considerable, but should not be 
induced by using too much cold water. The griping pains 
and nausea will be less, if weak tea or warm water is used to 
allay thirst. 

The cold applications, so agreeable and useful in other cases, 
are not called for in this*, as the skin is not usually very warm, 
and the head commonly free from pain. 

I have but one more remedy to mention — the specific, qui- 
nine. This is to be given on the better day, and on the morn- 
ing of the chill day, or worst day. Give about eight pills of 
two grains each, in the course of the day of remission, oras'it 
will happen, on the second, fourth, and sixth days. The next 
day, expect the chill, or prevent it by beginning with quinine, 
six hours before hand, and giving two grains hourly, in pills, 
or what is probably better, in solution. Laudanum may be 
combined with the quinine in these cases, if the symptoms of 
prostration are considerable. 

Under this mode of treatment, this violent form of bilious 
fever, wall commonly be arrested in five or seven days. I 
have cured many such cases, with bark and laudanum alone, 
before quinine was discovered, and I have always remarked, 
that the cure of these cases was almost sure to be perfect. 

Comatose slate. The word coma signifies, profound sleep, 
but has been long used to characterise a state of disease at- 
tended with stupor, or a sleep too deep to admit of being easi- 
ly aroused. This is frequent in bilious fever, and has been 
treated of as a particular variety by several writers. 

This is a high grade of bilious fever, frequently termina- 
ting fatally as early as the fifth day. There is nothing peculiar 
in its manner of attack. A light fever on the first day, with 
a remission on the second, followed by a restless night, brings 
around the third day. The slight chill which now comes on, 
produces but little uneasiness The case is usually consider- 
ed very mild, or probably not regarded as a bilious fever at all. 
The fever rises suddenly ; but the patient utters no com- 









BILIOUS REMITTING FEVER. 101 

plaint — is presently heard to breathe heavily, and, on exami- 
nation, found stupid, sometimes as unconscious, as in apo- 
plexy. Up to this time, the disease may have been thought of 
little consequence — now it is surrounded by all sorts of doubts 
and surmises. Is it apoplexy — is it from strong drink, or oth- 
er poison . ? If death occurs, the doubt is considered almost 
changed to certainty. Many die in this way who are not sus- 
pected to have died of bilious fever. But we must return to 
our narrative of the symptoms. 

The physician, perhaps suddenly called on, finds his pa- 
tient lying on his back, the attendants standing aghast, but of- 
fering no assistance. He takes hold of the wrist and finds the 
pulse full and bounding, but slow, probably not over eighty to 
the minute. He tries to arouse the patient, and if the«case is 
not extreme, partially succeeds. 1 have a very distinct re- 
membrance of a case in point. Having aroused m}- patient 
by shaking, he opened his eyes. I asked in a strong voice — 
"are you in any pain?" — he replied no — " then how are 
you ?" — well! said he, and closed his eyes. In other cases, 
the coma is so profound, that the patient cannot be aroused. — 
I have in such cases raised the lids, and the eyes remained 
opened, exposed them to bright light, and they did not move, 
but, with the pupil contracted, gave an indiscribably awful 
expression. This state of fever has been termed apoplectic ; 
but it differs widely from that disease. The coma, from fever, 
resembles a profound sleep — the patient is quiet and does not 
move. In apoplexy, there is great appearance of distress, and, 
in most cases, constant attempts to move some of the limbs. 
The heat of the body is much greater in fever, and the perspi- 
ration more profuse. I believe the patient who is comatose in 
bilious fever, is, in every instance, covered with a profuse per- 
spiration. His complexion is florid, and his eyes free from 
the tinge of bile. The coma does not last through the night; 
and the next morning (he physician finds his patient so far re- 
stored, as to give a fair account of his previous symptoms. 

The case will now be recognised as an attack of bilious fe- 
ver. Coma will return in the paroxysm, on the rise of lever, 
each alternate day. In all other respects it will progress as 

other cases, and run to an earlv crisis. 

7 <j 

treatment of comatose fever. 

The pupils of Doctor Rush, were taught to use no evacu- 
ants except on a full pulse ; but in these cases of coma, the 



102 BILIOUS REMITTING FEVER. 

lethargy of the patient hindered the administration of reme- 
dies, except on the days of remission, when the pulse did not 
seem to warrant those which were active. This, I confess, was 
a great source of embarrassment to me. With such views, 
I was thrown on the lancet and cold water. It was my prac- 
tice to bleed freely in coma, and to use cold water, applied by 
sponges or towels, to the whole surface, as long as I thought 
the symptoms required it. The practice was efficient and suc- 
cessful. But the theories then followed, went too much on 
the principle, that to subdue a paroxysm was to subdue the 
disease. It was not then suspected that a remedy with pow- 
er to arrest a paroxysm, might produce a prostration, which 
would invite another and a greater paroxysm. More experi- 
ence, and I trust sounder views, have taught me to take care 
of the strength of my patients. The means we have of redu- 
cing the quantity of blood and other fluids of the system, are 
remedies of great value, and should be used, but not abused. 

Bloodletting is a great remedy in coma, when it occurs in 
bilious fever. Sixteen or eighteen ounces of blood, drawn in a 
full stream from the arm, will, in almost every instance be suf- 
ficient. The operation should be performed as soon as the 
fever has attained its height. If the patient is robust, and the 
disease violent, a larger quantity of blood may be drawn. Let 
the practitioner decide on the quantity he will abstract, and 
take that and no more. Let no attempt be made to bleed till 
the pulse gives wav. Abstract the quantity } T ou deem neces- 
sary, and do not allow a show of faintness, during the flow of 
blood, to deter you from the sufficient use of this remedy. In- 
dividual temperament, enables one to stand up under an enor- 
mous loss of blood ; but subdues another as soon as the current 
begins to flow. Blood should not be drawn late in the dis- 
ease, or late in the parox} T sm. If the practitioner does not ar- 
rive in time, he had better forbear this remedy. Be ought to 
be a competent judge, bow long the paroxysm has still to last, 
if undisturbed by remedies; and I here give him my opinion, 
that if the paroxysm has spent its full force and is on the de- 
cline, though the pulse be strong, and the fever yet high, the 
bloodletting will do harm, rather than good. A paroxysm on 
the decline, does not require to be forced off by so powerful an 
agent — it commonly subsides with sufficient rapidity of itself. 

The next remedy is, the application of cold. The profuse 
perspiration which attends these cases, has been thought a 
reason for withholding the cold. I decide the question with- 
out the least hesitation. I have tried it fearlessly, and fully- 



BILIOUS REMITTING FEVER. 103 

and have no doubt of its great superiority over all other reme- 
dies, not even excepting the lancet. 

My mode of applying cold is this ; having waited till the 
chill stage is over, I take water, at the usual temperature of our 
springs or wells, apply it freely to as much of the surface as is 
thought necessary — using no ice to the head, or any colder 
water than that I have mentioned, to other parts — let the sur- 
face be exposed, and cool air applied by fanning. The phy- 
sician who will do this with his own hands, will be surprised 
at the rapidity with which the pulse will subside. Few cases 
will require the application to be extended be}^ond the face 
and arms, and perhaps the legs and feet. Let the surface on 
these parts be kept faithfully bathed, not by a timid and doubt- 
ing nurse, but I repeat, by the physician himself, and he will 
find the pulse give way, and his patient recover his senses in 
a surprisingly short time. I have so often found this occur in 
less than an hour, that I have of late seldom thought it neces- 
sary to use the lancet, even in coma. It will sometimes hap- 
pen, that the stupor will continue after the heat has been great- 
ly reduced, and the pulse has become almost natural. Let 
the bathing, in such cases, be suspended for a time. If the 
pulse should rise and the heat increase, return to the cold ap- 
plications, and the senses will probably soon return. Should 
the case prove untractable, and the stupor excessive, I would 
approve of the application of ice to the head; but I cannot call 
to mind a case, in which the coma has failed to yield prompt- 
ly to the cold water, with, or without bleeding. 

I have thus given the mode in which I treat the paroxysm 
in this form of fever. The remission and the smaller par- 
oxysm are to be treated as in other cases. Let a full dose of 
calomel be given on the day of the remission, and see that it 
operates before the next day. To accomplish this, give castor 
oil or seidlitz powders if necessary. A moderate operation 
by the bowels on the night of the second and fourth days, is 
all the cathartic remedy I have found it necessar}^ or I ma}" 
say, practicable to give. 

Quinine is our great reliance for the arrest and suppression 
of the paroxysms of this form of fever. Give it in full quantity, 
on the day of the remission, and on the mornings of the days 
on which the paroxysm is expected. I need not repeat the 
manner of doing this. 

I have found this a peculiarly instructive form of fever. — 
Taught to believe, that bilious fever was entitled to its name, 
irom its peculiar action on the bile-secreting organs, and that 



104 BILIOUS REMITTING FEVER. 

every paroxysm, which was allowed to pass without the dis- 
charge of bile by emetics or cathartics, produced an accumu- 
lation of bile which would tinge the skin, corrupt the blood, 
and otherwise produce great mischief; I regarded the stupor 
which rendered it impracticable to use these remedies, with 
special alarm. This embarrassment was the more felt, be- 
fore the discovery of quinine. The bark was not much re- 
lied on at best ; but it was considered dangerous where full 
evacuations from the bowels, had not been brought on. I 
have treated man}* cases of comatose bilious fever, without 
the use of bark or quinine, and with very slight evacutions 
from the bowels on the remission days alone. I found, not- 
withstanding these hindrances to my plan of treatment, that 
recoveries from this form of fever, were usually perfect, and 
that there remained after them less disorder of the stomach or 
of the liver and spleen, than after almost an}* other form. I 
inferred from this, that the liver was not always the seat of dis- 
ease in bilious fever. And I still entertain the belief, that our 
treatment of bilious fever should not be founded on the notion, 
that the removal of bile is the great business of the physician. 
The liver in certain cases forms enormous quantities of bile, 
and its discharge is unquestionably of essential service, but in 
the comatose state, the liver appears to act a subordinate part. 
It seems to act with no oreat energy, while the skin, in throw- 
ing off by perspiration, probably performs the same curative 
operation. I think the great point of comatose fever, is the co- 
pious perspiration which attends it. The mind is stupid and 
inactive, but the skin is much excited. If the bile is not pro- 
duced, perspiration is an effective substitute. 

A word more, and I have done with the comatose state of 
fever. The coma I have been considering, arises early in the 
disease, and is a regular paroxysm of every alternate day. — 
Let it not be confounded with the stupor which sometimes 
comes on at the close of a fever, where the patient sinks under 
a cold and protracted perspiration. 

CONVULSIVE STATE OF BILIOUS FEVER. 

Doctor Dunglison's definition of this form of fever is — "A 
pernicious intermittent, accompanied by convulsions." The 
cases I have seen, were not intermittent : but, a very high and 
dangerous grade of remittent fever. The symptoms were, in 
all respects, the same with other cases of bilious fever prevail- 
ing at the same time, with the exception of the convulsions. 



BILIOUS REMITTING FEVER. 105 

Convulsions seldom occur to grown persons, in remittent fe- 
ver. Children, seven years old or less, are the common sub- 
jects of them. The convulsions in these cases, have a close 
resemblance to epilepsy, and need not be described here. 

A few observations in relation to these cases will be all that I 
deem necessary. 

The first remark that I would make is, that there is no 
time at which the convulsion may be expected to come on — 
it may occur in the chill, or in the paroxysm of fever. Nor is 
it at all certain, that the patient who is attacked with convul- 
sion in chill, may not be attacked in the midst of the next par- 
oxysm, or perhaps not have it again during the continuance of 
the disease. Convulsions in fever, are to the last degree ir- 
regular in their returns, but not so in their peculiar symp- 
toms — these will be the same in every attack. 

Persons subject to epilepsy, will be apt to have a convul- 
sion in fever; and there are many children, who seem to be 
easily excited to convulsions, and will be convulsed in every 
paroxysm of fever, however moderate. In these cases, the 
convulsions seem not to increase the danger. 

But convulsions brought on, not b} 7 the temperament of the 
patient, but by the violence of the disease, are extremely dan- 
gerous. If they occur in the chill stage, the danger is still 
greater, and if the muscles of one side — the arm, leg, face, and 
neck, or any of them, take on convulsive motions, while the 
other side seems unaffected, the danger is greatest of all. I 
do not think I ever saw a single recovery, where the case as- 
sumed this form. 

REMEDIES. 

The warm bath has been extensively tried in this form 
of fever. The attack is usually, on a child, sudden and 
unexpected. Physicians, I have no doubt, introduced this 
practice. I think it pernicious, and have discountenanced it 
for twenty } T ears, but with so little success, that I still hardly 
ever reach a case of convulsions in fever, without finding my 
patient in a tub of warm water, 01 just withdrawn from one. 
The urgency of the case, seems to admit of no delay ; every 
one has seen the warm bath used for convulsions, and my 
opinion to the contrary, is forgotten or unheeded. For this 
reason I have seldom seen the first onset of these convulsions, 
treated as I would have desired. The warm bath is, I think, 
the most unmanageable of remedies. To a person in high 
fever, it is at first, very oppressive, and if continued at aeon- 



106 BILIOUS REMITTING FEVER. 

siderable heat, for a long time, it suddenly becomes the most 
exhausting remedy I have ever seen tried. Now, this (inal ef- 
fect, of reducing the system, would be a remedy for convul- 
sions, if it could be carried to the right extent and no further. 
But with the patient, a child, in a state of insensibility, I 
should feel at a loss in continuing, or staying the process. For 
this reason, and on account of having seen it tried, a hundred 
times, as I think, with little benefit, I object to the use of the 
warm bath. 

No state of fever produces a pulse of more activity, or a 
circulation of the blood more rapid, than the convulsive. The 
convulsions commonly last only a short time, and are followed 
by a deep state of coma, great heat, and the most throbbing 
and violent pulse. Sometimes the convulsions last longer, or 
are renewed after a short time ; but the stupor and violent cir- 
culation are the same. 

These symptoms seem to call for bloodletting and cold ap- 
plications. If I see a patient early in such a case, I open a 
vein and bleed freely. But this is sometimes not easily ac- 
complished in young children, and I have not unfrequently 
resorted to cold applications alone. In some cases the con- 
vulsions do not produce coma to such an extent, as to hinder 
the administration of remedies. In these cases an emetic is 
to be given. 

Where convulsions produce coma, all the difficulties attending 
the treatment of comatose cases, attend these also. The pulse 
in the remission, will remain full, and a degree of heat propor- 
tioned to the circulation, will be present. But these symptoms 
do not forbid the use of quinine. It is to be given freely, on 
the day of the remission, and for five or six hours before the 
coming on of the greater paroxysm on the next day. By treat- 
ing every paroxysm with cold applications, and by letting 
blood, while there is strength to bear it — and using the quinine 
as above directed, the cases of fever with convulsions will be 
as successfully managed, as by any other means, with which I 
am acquainted. 

No form of bilious fever is more difficult to treat properly 
than this. A physician ought always if possible to be present. 
And he should recollect that a fever in a grown person with 
coma, is almost the same with a fever with convulsions in a 
child. The treatment of the two cases is the same. 



BILIOUS REMITTING FEVER. 107 

GASTRIC FEVER, OR FEVER OF THE STOMACH. 

This is a bilious fever, affecting the stomach principally. It 
differs essentially from the nausea and vomiting of common 
cases, and as much from those attended with cholera morbus. 
The case now under consideration, attacks the stomach with 
such violence, that it seems the sole seat of the disease ; and 
other organs seem scarcely at all affected. There are two 
varieties of this affection, which I deem worthy of separate 
consideration. 

1. The first is known by intolerable thirst, burning pain at 
the pit of the stomach, vomiting, restlessness, and deep, or la- 
borious breathing. The attack at first, is without any peculi- 
arity, a fever with a mild and a violent paroxysm, on alternate 
days. On the third or fifth day, a violent vomiting seizes the 
patient. Every thing swallowed is instantly rejected. The 
matter thrown up may be bilious, but is not remarkable for its 
quantity ; great restlessness, and constantly increasing heat, 
and pain at the pit of the stomach, follow. The case is now 
one of great agony. Thirst, the most intolerable of the evils 
felt, is sought to be relieved by large draughts of cold water, 
which afford relief for a moment only. The countenance be- 
comes haggard, the features shrunken, the eyes hollow, the 
voice hoarse, and the strength of the patient gradually fails ; 
the surface becomes cold, the pulse rapid and feeble, and there 
is great danger of speed} 7 dissolution. 

Laudanum is a sovereign remedy for this state of the sys- 
tem. Give a tea spoonful, and if it is rejected, give instantly 
a second, and a third, if necessary, till one is retained. If it 
is found not to remain, give opium in pills to the same extent. 
(Under the influence of this remedy, the thirst will subside, 
the restlessness cease, and a state of delightful tranquility en- 
sue. A comfortable night will follow, and the next day will 
offer a fair opportunity to administer quinine efficiently, to hin- 
der the next paroxysm. I say nothing more in reference to the 
treatment. This case admits of no active treatment, by ope- 
rating remedies, in the paroxysm ; and, probably, will not re- 
quire more than a single dose of calomel, on the second or 
fourth night. 

With this treatment, this formidable disease gives way 
readily, and with but little loss of time. The danger of wrong, 
or inefficient treatment is great. I was once called, on the 
fifth day of the attack, to a case of this kind. The patient, af- 
ter a light chill, commenced vomiting. He took a dose of 



108 BILIOUS REMITTING FEVER. 

Glauber's salts, which did not arrest the vomiting. I saw him 
three or four hours afterwards, and found him vomiting almost 
constantly and swallowing cold water, by the half pint, every 
five or ten minutes. He had in this way, in two or three hours, 
taken nearly two gallons of water. His face began to look 
shrunken, and his voice became hoarse and hollow. He had 
no passage from the bowels. 

1 administered a tea spoonful of laudanum, which he retain- 
ed, and vomited no more. In an hour, his skin was covered 
with perspiration, and the paroxysm terminated in a remission, 
favorable to the administration of bark, which was so used, that 
he had no return of fever. 

I will relate another case. Gen. E. Brown of Hancock, re- 
sided sixteen miles from Milledgeville. He had this form of 
bilious fever, had struggled through the fifth day, and was again 
attacked on the seventh. I found him lying on his back, with 
arms extended, breathing deep, countenance haggard, and eyes 
dry and bloodshotten. He raised his arms on seeing me, but 
was too hoarse, and too weak to utter many words in con- 
nexion. He had been treated for inflammation of the stom- 
ach, with blisters, and I do not recollect what else. He was 
now evidently sinking, but taking only a few drops of es- 
sence of cinnamon, from time to time. This feeble remedy 
was thought all the inflammatory state of the case would sanc- 
tion, in the way of stimulants. He had great thirst, but for- 
bore the use of much water, and therefore vomited less fre- 
quently. 

I gave him a tea spoonful of laudanum, and ordered for him 
a glass of brandy toddy, with two ounces of biandy in it. — 
These remedies, taken at the same time, were retained. In 
an hour, he was covered with a warm perspiration, and ex- 
pressed himself as entirely relieved. The next day he was 
put on the use of bark — for it was before quinine had been in- 
troduced — and recovered without experiencing another attack. 
He lived to testify his gratitude, in a manner rarely equalled. 
2. The cases of belching, or eructation of bile from the 
stomach, are not so frequent, but more formidable than those 
I have been describing. They are also more irregular in their 
symptoms and times of attack. The terms, eructation and 
belching, conveying the same meaning, have been restricted 
to the raising of air from the stomach, and discharging it 
through the mouth. By a process exactly similar, fluids and 
solid matter contained in the stomach, are raised and ejected, 
or spit out. The process differs from vomiting, in being noise- 



BILIOUS REMITTING FEVER. 109 

less and without nausea. It appears to be an easy belching, 
but instead of air, fluids are raised. This process, when 
begun, is continued, if not arrested by powerful remedies, 
throughout the disease. Left to itself, I believe it proceeds 
uninterruptedly to death. I have never seen a paroxysm re- 
turn, after this state of the stomach came on ; and I had prac- 
ticed medicine many years before I had witnessed a recovery 
from it. I believe it does not often occur before the fifth day 
of the disease. The bile raised is always fluid — not ejected, 
as in vomiting, but spit out from the mouth like water. — 
At first, it is yellow, but becomes green, as the juice of 
wheat ; and, towards the last, I have seen the green mat- 
ter quickly settle to the bottom of a transparent fluid. The 
presence of the bile in the throat, is, at first, not com- 
plained of; but, after a time, it flays the mouth and throat, 
and is complained of, as if it were caustic. When these eruc- 
tations begin, the strength is but little exhausted, the skin soon 
becomes cold, and a dew of moisture is felt on the forehead. 
Gradually the strength fails, the mind gives w r ay, the patient 
still belches, and spirts the bile, over clothing and attendants ; 
hiccupping follows, and death occurs, frequently in a day from 
the attack of the eructations. 

These attacks are insiduous, and come on in cases not deem- 
ed violent. Having visited a gentleman who was indisposed, 
and administered medicine to him, he remarked that his ser- 
vant man was unwell and in need of medicine, and called to 
him to come in for examination. A robust young negro man 
obeyed the call ; and, as he was crossing the yard, with a 
light and firm step, stopped suddenly ; his shoulders were 
jerked up, and his neck bending, gave evidence of eructation. 
He spit out a large mouthful of bile. I learned from him that 
he had been two days unwell, but not so much so as to think 
of taking medicine ; that this was the first time he had raised 
any thing from his stomach in this manner, and that, even now 
he could not complain of much pain or sickness. On dismis- 
sing him, I could but admire the firm step, and graceful move- 
ment, by which he crossed the yard, as I was fully impressed, 
for his last time. I had not the least hope of his recovery, 
and so announced to his astonished master. Death was punc- 
tual. The poor fellow died in about thirty hours. This is one 
of many cases, of this kind, which I have witnessed. 

Treatment. Till the eructations have occurred, I have never 
observed any thing striking in this form of fever. The cases 
it has occurred in, have appeared so mild that I have always 



110 BILIOUS REMITTING FEVER. 

been taken by surprise, when these eructations have happened. 
Nor have I found the paroxysm run on regularly after this un- 
toward symptom takes place. Generally, the instant it is seen, 
the fever, or heat of the system subsides, and there is no return 
of chill or fever. The case proceeds, in a regularly descending 
course, to the end. L remember a single instance in which the 
eructations ceased on a day of interval, and again returned in 
the paroxysm of fever. 

It is obvious that the treatment of these cases, should turn 
mainly on the removal of the belching. This is to be attempt- 
ed by giving opium and camphor. Take of opium six grains, 
camphor forty grains, and compound them into twenty-four 
pills.* Give three of these pills hourly till the eructations 
cease, and afterwards one at a time, so as to give from 
eight to sixteen a day, as the symptoms may be more or 
less subdued. This remedy alone, has, in my hands, sup- 
pressed these fatal eructations. The length to which it 
should be carried cannot well be defined. I have often given 
the prescription of six grains of opium, and forty of camphor 
in the course of twenty- four hours, for three successive days. 
In a few cases I have given twice as much in one day. 1 hav 
seen delirium brought on by this remedy, and continue for a 
long time, attended with relief from the eructations and the 
final recovery of the patient. The first recovery I ever wit- 
nessed in such a case, was in a strong young negro man, who, 
under the use of the remedy, ran into a singular delirium or 
madness, which lasted for three weeks. Since then, I have 
never failed to prescribe opium and camphor, and with satis- 
factory results. 

The use of quinine is by no means hindered by the reme- 
dies I have been speaking of. I have found it rejected or 
belched up when given alone ; but, in combination with the 
camphor and opium, it has been retained, and I think with 
great benefit. The last case I witnessed, was successfully 
treated by laudanum and spirit of camphor, combined with 
full doses of quinine. I think the quinine should not be given, 
except at the period of the remission of the fever ; but after the 
first day of the eructations, when no remissions or exacerba- 
tions are to be expected, this great remedy should be vigor- 

* Camphor and opium are reduced to pills by first wetting the camphor in alco- 
hol, or spirit, and rubbing it into powder with the opium. Then make it into pills 
with strong mucilage of gumarabic. The same remedy may be given in powders, 
mixed in honey or syrup. Or it may be given in the form of laudanum and spirit of 
camphor, united, so as to equal the strength of the pills. 



n 



BILIOUS REMITTING FEVER. Ill 

ously administered, during the remainder of the case. I con- 
clude with the remark, that by the timely and judicious use of 
opium, camphor, and quinine, this dangerous form of bilious 
fever will be generally treated with success. 

FEVER WITH URTICARIA NETTLERASH, OR MAD ITCH. 

This is a form of bilious lever, attended with regular par- 
oxysms, a milder, and a more violent, on alternate days. The 
minor or lower paroxysms, are unattended with any peculiar 
symptoms ; the greater or morning paroxysms, are attended 
with urticaria. 

The disease is ushered in with a chill. As soon as this sub- 
sides, the breathing becomes very much oppressed ; great pain 
is felt in the region of the stomach ; the face becomes pale, and 
the whole surface, assumes a mottled or purplish hue — soon 
a violent itching is felt, on some part of the body, which quick- 
ly extends along the sides, and parts of the extremities. — 
Wheals appear, with their broad bases and white tops, and 
the restlessness, oppression, violent pain, and intolerable itch- 
ing, constitute this, a most painful disease. In a short time the 
skin becomes red, and a very high degree of feverish heat oc- 
curs ; the pulse, which had been in the outset feeble, is now 
full and bounding ; the wheals disappear, and by degrees, the 
fever subsides ; leaving the patient, exhausted, feverish, and 
uneasy. 

The next day is passed in comparative comfort, but at 
night, a low degree of fever, with restlessness, oppressed 
breathing, and some anxiety supervenes. Such are the great- 
er, and milder paroxysms, of this form of bilious fever. It 
pursues the same course, from day to day, to the end : it would 
therefore, be useless to extend the description. 

Treatment. The peculiarity, which I have found it neces- 
sary to make, in the treatment of this form of fever, has in- 
duced me, to give to it, a separate consideration ; as if it con- 
stituted a variety of the disease. This peculiarity consists in 
the avoidance of all evacuants — cold applications — bloodlet- 
ting, or other depleting or weakening remedies, on the day of 
the greater paroxysm. When I am called to a patient, labor- 
ing under this oppressive form of fever, I administer lauda- 
num ; a tea spoonful, if the case appears violent, or a less 
quantity — 40 or 50 drops, if it seems less threatening. If the 
patient has not previously taken calomel, I combine it with 
the laudanum. The operation of the calomel given in this 



112 BILIOUS REMITTING FEVER. 

way, cannot be expected to take place, in less than ten or 
twelve hours. This operation will take place in the remission 
of the fever, and should not be increased by the administra- 
tion of other cathartics, unless the calomel fail for twelve hours 
to produce its effect. In this event, a moderate dose of castor 
oil should be given. A very gentle operation from these ca- 
thartics, is all that is required : and, it should be borne in 
mind, that in this case, cathartics are apt to prove drastic, at- 
tended with much pain, and frequent discharges. To obvi- 
ate this, laudanum should be given, in doses suited to the oc- 
casion. 

The whole treatment of this form of fever, on the day of 
the greater paroxysm, consists in administering opium and 
calomel. The opium may be given in the form of laudanum, 
morphine, or Dover's powder, in doses suited to the case. 
The calomel may be given in the paroxysm, or on the next 
day ; but it should, in this case, be made to operate more 
briskly, by the use of castor oil, or Epsom salts, given with- 
in an hour or two after the calomel is administered. 

I have said, that cold applications are improper, in the par- 
oxysms of this form of fever ; cold drinks are to be used with 
equal caution. If the patient is allowed to indulge, in 
draughts of cold water, proportioned to his thirst, violent pain 
and spasms in the stomach and bowels, may be apprehended. 
Contrary to ordinary experience, I have found warm drinks, 
especially warm tea, more agreeable, and more allaying to the 
thirst, in these cases, than the cold drinks, which the patient 
would have desired. 

A single additional remedy, and I have done with the treat- 
ment of bilious fever with nettle rash. This remedy is qui- 
nine. It should be given on the day of the remission, and on 
the mornings of the days of the paroxysms, as has been ad- 
vised, in ordinary bilious fever. 

The small variety of medicines advised in this form of bil- 
ious fever, makes it proper I should state, that they are uni- 
formly successful. The only cases of bilious fever, with ur- 
ticaria, which I have ever seen to bring the patient into great 
peril, were aggravated in their violence by the improper use 
of drastic emetics, or cathartics. 



BILIOUS REMITTING FEVER. 113 

HEMORRHAGE, OR COPIOUS DISCHARGE OF BLOOD FROM THE 
STOMACH OR BOWELS. 

Copious discharges of blood, ejected from the stomach, or 
passed by the bowels, in the paroxysm, occur only in a very 
high grade of bilious fever. Unlike the hemorrhage which 
occurs in the closing scene in typhus, this makes its appear- 
ance in the earliest stage, or first violent paroxysm. Soon it 
appears to be the absorbing feature of the case, and death or 
life, manifestly depends on its extent. 

The attack, in this form of bilious fever, is violent from the 
first. On the morning of the third day, a slight chill may be 
expected. Heat and a full pulse, with great restlessness, 
follow. A violent vomiting ensues, but with no appearance of 
bile ; but in the course of an hour, after numerous efforts to vom- 
it, a large discharge of blood from the stomach takes place. 
This blood looks entirely fresh, and more florid than if just 
taken from a vein. It is seldom coagulated when thrown up, 
and is frequently nearly free from any admixture. After 
several times vomiting, and a large discharge of blood in this 
way, the blood seems to find its way through the bowels, and 
is thus discharged in equal purity. The quantity of blood, 
which I have seen discharged in this way, in a few hours, is 
enormous. I have never had an opportunity of ascertaining it 
exactly, but it has unquestionably extended to more than three 
quarts. The patient bears up, wonderfully, under this dis- 
charge — I have never seen one faint. As soon as the dis- 
charge of blood commences, the heat and other symptoms of 
fever disappear, and it appears to be a case of simple bleed- 
ing. The discharge of blood ceases, after having continued 
for several hours, and a night of great prostration, but quiet 
follows. The next day a very light degree of fever may be 
observed ; at night it will increase, with restlessness, and 
nausea, but no vomiting. 

The next is the day of the greater paroxysm, and will 
probably terminate the case. The hemorrhage will return ; 
and death or recovery awaits its termination. It rarely re- 
turns a third time ; indeed I do not recollect to have seen a 
third attack of this hemorrhage. 

This form of fever, seems to threaten life, w T ith instant ex- 
tinction ; but I have rarely seen it fatal. It is rather uncom- 
mon — I do not think I have seen more than ten cases ; and 
five or six of these occurred the same year. 

Treatment. Whether this disease is a curative process, not 
8 



114 BILIOUS REMITTING FEVER. 

tending to the destruction of life, cannot readily be ascertained. 
It will seldom be allowed to run its course without remedies, 
and to these its favorable issue will probably be attributed. 

I advise the following prescription. Take of opium three 
grains, sugar of lead six grains, make into pills, and give at 
one dose. The remedies may be combined in powder, or the 
opium given in any other form. The discharge of blood will 
probably cease in half an hour ; but if it does not, and the 
patient seems to be sinking, a smaller dose may be given, in the 
same way, and repeated, from time to time, according to the 
urgency of^ the case. Applications of cold water may be 
made to the pit of the stomach, by towels ; and the heat kept 
down by sponging, or wetting the extremities, with cold water, 
and keeping up a current of cold air, by the use of fans. 

No cathartic, or evacuant whatever, will be required. With 
my present views of the subject, I should give a dose of calo- 
mel, on the days of the remission ; but from my past experi- 
ence, I am bound to say it is not indispensible. I have not 
seen a case of this form of fever, for many years. During the 
time I met with occasional cases, it was so much my practice 
to avoid evacuants, on the day of remission, that I gave noth- 
ing of the kind, in these formidable cases. Nor did I venture 
on them, during the discharges of blood ; for this was so exces- 
sive, that I thought it fully equivalent to bloodletting, cathar- 
tics and emetics combined. Giving as I did, the opium and 
sugar of lead, in the paroxysm, I was left with the day of the 
remission, to give the Peruvian bark in some form. 

This mode of treatment, was, in my hands, abundan tly suc- 
cessful. Not only did every patient 1 was called to, in this 
case, recover ; but the recovery was perfect. No yellowness 
of the eyes, enlarged spleen, or inflamed liver, followed, in a 
single case. The extreme paleness and debility were rapidly 
recovered from, and the return to a full enjoyment of health and 
strength, was surprisingly quick. If therefore I were now to 
treat a case of this kind, a very moderate dose of calomel, on 
the day of the remission, is all the evacuant I should give. 
And I should think it immateiial whether the operation was 
effective or not. 

But on the day of remission, and on the morning of the ex- 
pected paroxysm, let the great specific, quinine, not be for- 
gotten. Give ten grains in the course of the well day, and 
from fifteen to twenty grains, in the six hours previous to the 
expected attack, on the day of the paroxysm. 



BILIOUS REMITTING FEVER. 115 

PROTRACTED CASES OF BILIOUS FEVER. 

In this class, I include all cases which continue longer than 
eleven days. This may occur, in any of the forms of which 
I have been speaking ; but is most likely to happen in the 
milder forms. I think I have observed it oftenest in children, in 
which delirium had been a leading symptom. I have also ob- 
served it to follow cases in which medicines had operated ex- 
cessively, npt from the quantity given, but owing to the pecu- 
liarity of the case. It occurs most frequently late in the sea- 
son, and I have seen it affect several persons of the same fami- 
ly, at the same time. 

When bilious fever has continued beyond the eleventh day, 
it is uncertain in its course. It no longer presents the violent 
paroxysms of its earlier stage ; and being attended with great 
debility, dryness of the tongue, and delirium, has been im- 
properly called typhus. The symptoms in different cases, vary 
beyond description, and cannot all be set forth in books. 
There are yet certain resemblances, which, taken in connex- 
ion with the original attack, sufficiently identify the disease. 

The protracted bilious fever, is not only known from its be- 
ing a mere continuance of a fever of that kind, but that it is 
still a fever of paroxysms. This sufficiently distinguishes it 
from typhus, for which it is so often taken. These parox- 
ysms, it is true, are less marked, than in the outset of the dis- 
ease, and there is seldom a chill to mark the fever days. Still 
there is a better and a worse day ; and sometimes two or three 
days of very slight, and one day of severe fever. The pa- 
tient, in a few instances, becomes sallow, swollen, and dropsi- 
cal ; but generally pale and lean, with tongue dry and red, or 
coated with a brownish fur. 

These cases often continue to the end of the third week, 
without producing any visible local disorder; but when this 
term is reached, the case becomes more inflammatory; with 
cough, pain in the breast or side, enlarged and painful spleen, 
or perhaps swelling, or rising, at the angles of the jaws. The 
inflammation and suppuration of the liver, so common in the 
East, I have never witnessed. 

Treatment. Some of the ablest writers of the present day, 
will say, treat all these cases in the same way. They will tell 
you that quinine is the great specific of bilious fever, from first 
to last. Give it in the paroxysm, give it in the interval, give it 
to check dropsy arising from this cause, and give it to remove 
swelling and inflammation from the liver and spleen. 



116 BILIOUS REMITTING FEVER. 

I have already suggested doubts of the benefit, of this 
sweeping manner of using a great remedy. My opinion is, 
that these eases require, each for itself, a particular investiga- 
tion. Quinine is the great specific for paroxysms of fever. 
While there are chills, or if without chills, there are by 
turns a high fever, and intervals or remissions ; T do not doubt 
the great advantage of giving quinine, in these intervals or re- 
missions. How long it shall be continued, or to what amount 
given, are unsettled questions. I think from ten to fifteen 
grains, a day, given in doses of two or three grains, hourly, till 
the desired quantity is taken, will be a sufficiently liberal use 
of this remedy. This use of quinine may be made, when the 
fever has lasted more than eleven days ; although it may have 
been tried during the earlier and more violent part of the dis- 
ease. I would so use it, for four or five days ; but if, with no 
amendment, I would hesitate to press it farther. 

But there are other remedies besides quinine, which are of 
great use in these cases. The first of these, which 1 shall 
mention, is cold water. This is not requisite at all times, or 
even every day; but when there is a considerable rise of fe- 
ver, whether preceded by chill or not, the affusion of cold 
water, on the extremities, or extensively on the body, if there 
is great heat, will be of essential benefit. This remedy, with 
briskly moved cool air, should be continued till the pulse is 
sufficiently reduced, or till the patient will not willingly bear 
its longer continuance. This will seldom require more than 
half an hour; but should the remedy be suspended, and the 
heat, pain, and restlessness return, it may be repeated. 

In the application of cold water to the surface, it has been , 
thought necessary to suspend it, if a roughness of the skin, re- 
sembling the skin of a goose, appears. This has been the 
more insisted on, where the patient shuddered at the applica- 
tion. This rule is by no means universal — oftener wrong than 
right. This shuddering at ^he application of cold water, is 
frequent in the most inflammatory cases, and it is in these the I 
remedy is of most service. It may call for some caution in 
the mode of administering the remedy — the first water appli- 
ed may, beneficially, be warmed to seventy or eighty degrees ; 
or it may be cautiously applied, first to the hands and face, 
and then by degrees to other parts ; but when it has been for 
some time continued, the shuddering and roughness of the skin 
will disappear, and the remedy become as grateful as in other 
cases. The remedy is called for to reduce heat, allay thirst, 



BILIOUS REMITTING FEVER. 117 

and to moderate the circulation, and should not be lightly giv- 
en a p. 

Three years ago, I was called to a distant patient, where I 
arrived at nine o'clock at night. She had a light chill in the 
evening, and had, at the rise of fever, rathei increased in her 
shivering and complaint of cold. Warm teas and opiates had 
been given, and she was covered with, I know not how much 
bed-clothing. She had been ill for many days, had a rapid 
pulse, was very much prostrated, and bathed in a profuse per- 
spiration. On introducing my hand under the cover, I felt a 
high degree of fever heat ; but on withdrawing her hand into 
the open air, it soon became ccol and dry, with the character- 
istic roughness along the back of the arm. Such was her 
prostration and rapidity of pulse, that she could not be thought 
otherwise than in imminent danger. 

My mind was in a moment made up, to try the affusion of 
cold water: a remedy which can seldom do harm, where a 
great degree of extra heat is present. I called for tepid water 
and applied it, with my hands, to the face and hands, order- 
ing at the same time a brisk current of air from fans. In a 
few minutes, the water was made cooler, and the cover lessen- 
ed. In ten minutes, the coldest water became agreeable ; and 
in half an hour, by the most extensive use of this remedy, my 
patient seemed like one raised from the point of death. Not 
an unpleasant symptom occurred afterwards. 

Calomel is not to be forgotten in these cases. Four or five 
igrains, given every second night, and allowed to operate once 
or twice the next day, will generally be sufficient; but if the 
case proves obstinate, give three or four grains, daily, till sali- 
vation comes on. 

Where the liver, or spleen is acutely inflamed, frequent and 
small bleedings have seemed to me very serviceable. With 
these I have combined the use of antimonial powders, as fol- 
lows: Take of tartar emetic two grains, nitre one drachm : 
rub together and divide into twelve powders. Of these, give 
,one every two or three hours during the fever ; but not whde 
giving quinine. Caution is also necessary, that the operation 
of these powders shall be suspended, or checked with lauda- 
num, if the}' operate on the bowels. 

DISORDERS ARISING- FROM BILIOUS FEVER. 

Besides the intermittents, which sometimes follow attacks 

; of bilious fever ; there are disorders exceedingly important to 

be understood, and often dangerous, to those who have sur- 



118 BILIOUS REMITTING FEVER. 

vived the violent stage of the disease. These disorders, so 
far as I have observed them, affect chiefly, the liver, spleen 
and intestinal canal. However violent the disease may seem 
to act on the brain and nerves, the lungs, or the heart and ar- 
teries, these organs are but little subject to permanent, or fatal 
disorders, from bilious fever. But on the liver, spleen and 
intestines, its action is more fatal; and in many cases where 
there have been recoveries, these organs remain diseased, for 
an uncertain time. 

The disorder of the spleen is common, after recovery from 
fever. This organ seems to be alwa} r s excited, and distended 
in the paroxysms of fever. It is a common seat of pain, and 
is frequently so enlarged as to be plainly felt with the hand, 
before the case has passed the second paroxysm. This en- 
largement, when kept within certain limits, seems not to in- 
crease the violence of the disease, and its termination is as 
early, and as safe and regular, as in other cases. But the soft 
substance of the spleen, seems, not always capable of resist- 
ing the violence, with which the blood is thrown into it. Dis- 
organization and inflammation follow; and although the bilious 
fever ceases its paroxysms, in seven or nine days, a light in- 
flammatory fever, with great enlargement and tenderness of 
the spleen, continues. The patient rises from his bed, but not 
to enjo}^ health, or to long continue, free from danger. 

The liver is frequently affected at the same time, and nearly 
in the same manner, with the spleen. Pain and enlargement 
affect both ; and inflammation and fever become more perma- 
nent. The action of the liver is more conspicuous. Some- 
times indeed it seems inactive or torpid ; but generally its ac- 
tivity is evidenced in the copious discharges of bile from the 
stomach and bowels. In other cases the bile is not seen dis- 
charged in this manner, but flows out into the blood, tinging 
with its saffron hue, the eyes, the skin, and all the secretions 
of the system, especially the perspiration and urine. To these 
obvious symptoms follow, low inflammatory fever, tenderness 
and pain of the liver, with disorders of the stomach, head- 
ache, &c. 

In a few instances, I have seen bilious fever terminate in 
dysentery, with the ordinary inflammatory symptoms of this 
complaint. These cases are rare, and have, in my hands, 
yielded to the common remedies for dysenter} T . A more com- 
mon, and much more fatal termination, is a diarrhoea, with 
large bilious discharges, accompanied with fever and great 
thirst. In these cases, the fever seems to come on in the eve- 






BILIOUS REMITTING FEVER. 119 

ning, and to terminate in the latter part of the night, by copi- 
ous discharges of bile, with crude, indigested matters. In 
the morning, the patient, pale and languid, has less fever, but 
a full and bounding pulse, and rises from bed with a keen ap- 
petite for food. Such cases, at first, excite but little alarm, 
but they are exceedingly unmanageable and dangerous. 

Treatment. I have already given an account of the treat- 
ment of bilious fever, so long as it retains its character of par- 
oxvsms and remissions. While these symptoms continue, it 
is conceded that a successful treatment must be founded on 
quinine. In the cases now under consideration, this great 
remedy loses its place, or at least, its pre-eminence. 

My mode of treating an enlargement of the spleen, when 
attended with light i'exer and disordered digestion, is to apply 
a blister over the inflamed organ, and give calomel, in doses of 
three graines, daily, till a slight salivation ensues. By this 
time the blister will be healed, and I order tincture of lodyne, 
applied over the spleen with a feather, but not continued more 
than two or three minutes, so as to avoid blistering the part. 
Let this remedy be applied, from day to dav, so as to keep up 
some irritation for a week or ten days. If the disease does 
not subside, give the tincture of iodyne internally — from ten 
to twenty drops, twice a day in water. Continue this till a 
reduction of the swelling is accomplished, or till the remedy 
produces tremor, prostration of strength, or inflammation of the 
mouth or throat. The swelling of the spleen will seldom re- 
sist these remedies; but should it do so, they are, for a time, 
to be discontinued. Low diet, cupping, leeching, and, in the 
event of much inflammation, bloodletting, will be useful, in ad- 
dition to the above remedies. 

Inflammation of the liver, seldom in this country, tends to 
suppuration, or the formation of matter. Never having seen 
this result, I should not readil\ T suspect its approach. Never- 
theless, I regard bloodletting, indispensible, in these inflamma- 
tions of the liver. I prefer the abstraction of small quantities, 
at short intervals — half a pint once or twice a week. At 
the same time, give calomel, from four to ten grains a day, till 
a salivation appears. If the attending fever is high, and the 
pain in the right side, which characterises the disease, is se- 
vere, give antimonial mixture in doses, not to operate too ac- 
tively, and apply blisters or leeches over the region of the liver. 
By a vigorous use of these remedies, inflammation of the liver 
will seldom fail to give way, in a week or two. 

The bilious diarrhoea which follows bilious fever, is far 



120 BILIOUS REMITTING FEVER. 

more formidable than inflammation of the spleen or liver. 
This is a chronic disease, continuing, in some cases, for months. 
With very poor success, I have tried opium and calomel, in all 
the forms I thought adapted to the particular symptoms of each 
case, and have come to the conclusion, that they are not the 
best remedies for these cases. I advise bloodletting, a very 
spare diet, light cooling drinks, and blistering over the liver. 
If the stomach seemed oppressed after eating, I should advise 
a few grains of calomel and opium, if any of the above reme- 
dies seemed to operate on the bowels, producing excessive 
discharges. These remedies might be varied, and used, from 
time to time, while the case continued. 

In all these cases, there is great doubt whether there is not 
yet a reasonable hope from the use of quinine. I think the 
trials I have made of it have not been very beneficial: but if 
I again meet with these remains of high bilious fever, I shall 
try this remedy once more. I shall choose the time of least 
fever, and give quinine in doses of ten grains, once or twice a 
da}^, as the case may seem to a,llow. Laudanum may be com- 
bined, if necessary, and I should advise it where the case puts 
on an inflammatory or painful type. These remedies are not 
to be tried to the exclusion of those above directed. They 
may be used in harmony, and as auxiliaries ; but require the 
best judgement of an experienced physician, to ensure their 
beneficial administration. 

Change of climate is not to be forgotten, in the list of reme- 
dies, for these imperfectly cured cases of bilious fever. The 
patient should, if possible, leave the district of malarious dis- 
eases. His remedies may be continued, if circumstances ad- 
mit of it, but let nothing detain him long in a sickly atmos- 
phere. I think a higher, is of more consequence than a cooler 
region. The mountain regions of Virginia, North Carolina, 
Georgia and Tennessee, are celebrated for the restoration of 
health to these invalids. Their watering places need not be 
mentioned. But I have observed, in diseases of the liver and 
spleen, that the mountain limestone water seemed to have a 
specific power. I have witnessed the relief afforded to these 
cases, by a temporary residence in the limestone region of East 
Tennessee, and in the mountain region of Georgia. In some 
of these cases, the limestone water, at first, operates as a ca- 
thartic ; but carefully used, it proves the most efficient remedy, 
and, in a few weeks, enables the sallow and cadaverous pa- 
tient to return to his unhealthy residence, with renewed powers. 
Care should be taken to find proper water in a healthy place. 



BILIOUS REMITTING FEVER. 121 

Prognosis. The judgement formed of the probable result of 
a disease, is termed a prognosis. This judgement, proverbi- 
ally fallible, ought not, in dangerous cases, to be withheld from 
our patients, or their friends. When it is unfavorable, it should 
not be expressed with too much confidence ; for the pain it in- 
flicts is not warranted, except the result is nearly certain. 

This essay is already lengthy ; but long as it is, it contains 
but a condensed view of my own experience in bilious fever. 
The symptoms which signify the presence of danger, will be, 
in part, drawn from cases I have not particularly described. 

Danger, in fever, arises from the disease, or fatal injury, of 
vital organs. This, I am apprised, cannot always be proved ; 
but, in bilious fever, I have observed that the danger is greatest, 
where the liver, spleen, stomach and intestines, are the mani- 
fest seats of the disease. These are the organs which I think 
most affected, in this disease. The brain and lungs, equally 
important to life, are seldom the seat of the fatal action of bil- 
ious fever. 

These opinions are drawn from experience. Great pam in 
the liver, spleen, stomach or intestines, is alwa}^s an alarming 
symptom. It is worse if the case is attended with unequal 
distribution of heat; or if there is great heat about the abdo- 
men and chest, and cool extremities. These pains signify the 
same danger if they last only during the paroxysm of fever, or 
for a longer time. Vomiting is not a symptom of danger ; but 
a belching up of the fluid contents of the stomach, especially 
bile, is a signal of great danger. Hickup is also a dangerous 
symptom, when it occurs at the close of the disease, in an ex- 
hausted patient. The brain and lungs, on the contrary, seem 
seldom to be affected with fatal violence. The lungs are sel- 
dom affected with great pain ; but, however the breathing may 
be affected, in this disease, it seems not to affect life. Equally 
favorable is the prognosis from affections of the brain. Great 
pain in the head, if it even produces delirium, is no just cause 
of alarm ; and coma, resembling apoplexy, is frequently met 
with, in cases attended with but little danger. Pains in the 
back and limbs, so far from being dangerous, are noticed by 
Dr. Rush, as symptoms promising recovery. 

A sudden coldness of the body, occurring after the chill, is 
dangerous. These cases have, inconsistently enough, been 
termed the algid, or cold form of fever. They denote a giv- 
ing way of the powers of nature, before the force of disease. 
They are attended with a moist surface, and marble coldness 
of the flesh ; sometimes with wonderful calmness of the mind, 



122 BILIOUS REMITTING FEVER. 

and freedom from pain ; but, in other cases, with intolerable 
thirst, great restlessness, and complaint of burning heat. The 
patient, with pale, moist tongue, haggard countenance, and, 
flesh as cold as marble, demands cold drink, cold air, and cold 
affusions of water, over his body and limbs. His time is at 
hand. 

A full and bounding pulse is not a just cause of alarm in 
bilious fever. But when convulsions occur with such a pulse, 
the case is sometimes suddenly changed. If vigorous meas- 
ures are taken to reduce the circulation, a favorable result may 
be looked for, unless the convulsions attack the muscles of one 
side only. When this occurs, there is no hope — I think that 
in such cases, there has already occurred a fatal injury of the 
brain. A pulse, feeble and compressed, from the first, or in 
each paroxysm, with pale and purplish face and lips, attends 
the congestive fever; a form of this disease always danger- 
ous. Great heat about the body, is no proof that nature will 
rally and throw off the disease. 

These remarks may give to inexperience, some confidence, 
in forming a judgement of the probable result of a case of fe- 
ver; but an opinion should not be hastily formed. 

GENERAL OBSERVATIONS. 

A few general remarks, and I have done with the treatment 
of bilious fever. 

It is, in this country, very important that the bilious fever 
should be known from all other diseases. This is so far from 
being the case, that I scarcely pass a year, without witnessing 
manifest mistakes on this head. To avoid these, let the phy- 
sician bear it in mind — 

1. That bilious fever is a disease of summer and autumn. — 
In temperate climates, it never originates in winter or spring; 
and if, in these seasons, persons are attacked with fever, it is 
never a fever of this class. 

2o The symptoms of bilious fever, are beyond measure, va- 
rious. They have a single feature which is uniform — they 
are attended with paroxysms and remissions. 

3. In a very great majority of cases, the paroxysms are on 
alternate days, and are composed of a slight chill, followed by 
a burning fever. The next, is a day of remission, with a won- 
derful exemption from all appearance of serious indisposition. 

4. If the disease is without remissions, and has occurred in 
a hot climate, in the heat of summer, it may prove a yellow 
fever. 






BILIOUS REMITTING FEVER. 123 

•5. Never regard the discbarge of bile, by vomiting or stool, 
as a reason for calling a disease a bilious fever. Tbis is a 
mistake, as fatal as it is common. 

Left to itself, bilious fever has a beginning, a middle, and an 
end — commonly it has reached its highest point, by the third or 
fifth day, and by the seventh or ninth, comes to its termina- 
tion ; but many cases continue to the end of the third week. 

Each paroxysm has also, its beginning, its highest point, 
and its termination. These succeed each other with wonder- 
ful exactness, as to time and symptoms ; and contend, like an 
antagonist, till they are victors or vanquished. 

Doctor Rush opened his lectures on this disease with the 
startling question — " Do we ever cure a fever V It is now but 
little over thirty years, since I heard this, from the lips of him, 
who was then regarded as first in talents, and first in experi- 
ence, in his profession. It contains, in six words, the humilia- 
ting acknowledgement, that the science of medicine had not 
arrested the steady march of bilious fever, through the stages, 
and to the termination, mentioned above. Thirty years have 
enabled us to answer Doctor Rush's enquiry ! Yes, we do often 
cure fever ! Not only do we, by well directed medicines, ward 
off the blow of death from our patients ; but, in thousands of 
instances, cut short, in its full career, the most fatal forms of 
bilious fever ! This triumph over the great destroyer of our 
race, is the great achievement of medicine in this age. Let 
the physician then, bear it in mind, that he is, in a very great 
degree, responsible for the lives of his patients, in bilious fever. 

The remedies for this disease are few ; but they are pow- 
erful. Every body knows them ; but no one has more than 
sufficient skill to administer them properly. 

The first object in the paroxysm, is to lessen the heat, and 
reduce the violence of the circulation of the blood. The first 
object is obtained by the application of cold water, and free, 
cool air. The next, by bloodletting, emetics, and cathartics. 
It should be borne in mind, that bloodletting is the only one 
of these, which it is in our power to use, at the exact time, and 
to the exact extent, that we should desire. This won for it the 
trumpet, of the eloquent Doctor Rush. He treated every par- 
oxysm as a new case ; and prescribed, as if to regulate the 
circulation for the moment, was to destroy the disease. Ex- 
perience taught me to rely less on this remedy. Reason sug- 
gested, that if used at all, bloodletting should be performed on 
the rising paroxysm, to lessen the dangerous violence of the 
circulation. This, in my hands, it often effected ; but the time 



124 BILIOUS REMITTING- FEVER. 

at which it should be performed, could not well be left to the 
judgment of another ; and the physician, with many patients 
on hand, could not attend, at the moment this operation was 
called for. It became important to find a substitute ; and this 
has been found in nitre and tartar emetic, given as an active 
emetic, or in a more gradual manner, according to circum- 
stances. This remedy I regard as fully equal to the lancet in 
efficacy ; and, in many respects, far superior to it. It may be 
safely left with a nurse, to be given at the rise of fever. Its 
active operation is nearly certain, and the limit to which it 
should be carried, can be regulated by the degree of fever pres- 
ent. It is, in my opinion, so fully capable of controlling the 
circulation, that the lancet can hardly ever be requisite, where 
it is given. These are the remedies for lessening the violence 
of the paroxysm of fever. They are few, but ample. They 
are to be used according to the necessity of the case, gradually 
reducing their quantity and force, as the case may decline, 
from the deepest coma to a slight paroxysm, in a case of long 
standing, or low grade. 

Auxiliary to these remedies, there are two ; calomel and 
opium. The last mentioned is especially important, when, in 
the decline of the paroxysm, emetic or cathartic medicines ope- 
rate excessively. In these cases, it is to be given in full doses, 
repeated till the action of the medicine is arrested. But in 
other cases, where the fever has passed its highest point, and 
there is a dry skin, restlessness, thirst and other symptoms of 
irritation, give opium ; especially its best preparation, lauda- 
num, in a single full dose. But the use of laudanum is not 
restricted to the paroxysm, or its declining stage. It is given 
advantageously with quinine, in the interval, and in the con- 
gestive form. 

I have said that cathartics are to be used to lessen the circu- 
lation. They are decidedly inferior to the remedies above 
mentioned. This inferiority, is chiefly because of their un- 
certainty of operation. They cannot be made to operate at 
the pleasure of the physician ; and greatly did I feel the force 
of this evil, when early in my pratice, I relied more on cathar- 
tics for depletion. They are still important remedies. Calo- 
mel, ^by far the best, is not a cathartic only. Its operation on 
the liver is highly beneficial. I have said that the presence of 
bile in the discharges, proves nothing of the nature or charac- 
ter of a fever. But in bilious fever, a free discharge of bile in 
the early stage, is always salutary. Calomel, when operating 
as a cathartic, seldom fails to produce bilious discharges ; and, 



BILIOUS REMITTING FEVER. 125 

in this way, it is highly beneficial in bilious fever. The de- 
gree of its superiority over other cathartics, is such, that I wil- 
lingly award to it a special curative influence, over this dis- 
ease. But, it is with but little regard to its depleting, or re- 
ducing power, that I give calomel. While I give it the highest 
place in value, I assign it the lowest as a means of reducing 
the circulation. I give it at any stage of the disease, whether 
in the paroxysm or interval ; and while I rely on it, for the 
most efficient and satisfactory remedy, to discharge the offend- 
ing contents of the bowels, I think its operation, even in the 
hour of a dangerous crisis, is incomparably safer, than any 
other. Yet I am no hero in the administration of calomel. — 
Ten grains is my common dose ; and few of my patients, in an 
eight day fever, take more than twenty or thirty grains. I 
will not salivate one, in one hundred cases. 

With regard to other cathartics, I have but little to sav. I 
rely on them chiefly to keep up a reasonable action on the 
bowels. If calomel is desired to operate on the day of the in- 
terval of fever, castor oil is the best auxiliary. A small dose 
of it should be given from four to six hours, after the calomel. 
But, if this operation is desired during the paroxysm, give 
seidlitz powders, or antimonial mixture. Where the pa- 
tient is robust, and the medicine desired to be active, give 
cream tartar and jalap, in place of seidlitz powders. 

In the administration of these remedies, let the physician 
recollect, that a bilious fever is a disease, not of one, but many 
paroxysms. He is not therefore to take hold of the pulse, and 
fancy that its reduction to the healthy standard, is all he has 
to do. He is probably to witness the pulse, in a few hours, 
sink far below that standard, and if not Controlled, return, like 
a tide, to overwhelm his patient. He is to study the case be- 
fore him ; view patiently the progress it has made, and scan 
the ground it has yet to occupy. He will then be prepared to 
offer his remedy, in proper time. 

But the great and true remedy for bilious fever, is yet to be 
mentioned. The Peruvian bark and its preparations, have 
been long known as remedies for intermittent fever; and have 
been as long used or abused, in the treatment of the higher 
grades of this disease. The discovery of quinea has put this 
invaluable remedy into our hands, in a form to be used suc- 
cessfully. All agree in considering it the best remedy for bil- 
ious fever. The only questions are as to the time and the 
manner of using it, and the quantity to be given. 

1. In the first place, I advise the use of sulphate of quinine, 



126 BILIOUS REMITTING- FEVER. 

in the interval or remission of fever. I will not write out an 
argument against its administration, in the parox} 7 sm. I have 
tried it, and do not hesitate to say, that if there is a remission, 
that is the best time for the administration of this remedy. If 
the time of a paroxysm can be safely calculated on, the reme- 
dy should be given, so as to be in full operation, at that time. 

2. In the second place, I consider quinine a remedy of du- 
rable activity ; not giving way in an hour or two, but continu- 
ing for man}' hours. Let it be given, in broken doses, at hour- 
ly intervals, till the hour in which its action is deemed essen- 
tial. This will lessen the danger of being disappointed of 
our remedy, if the fever rises a little earlier than was expected. 

3. Thirdly, I think twenty grains of the sulphate of quinine, 
a sufficient quantity to be given between one paroxysm and 
another, of bilious fever. This may all be given on the da}% 
or within the six hours previous to the expected attack ; or, 
if the remissions allow of it, give ten grains a day, for two 
days successively. I think doses of two grains large enough ; 
and they may be given at hourly intervals. In cases of great 
malignity, these doses might be increased ; but I think there 
will not often occur a necessity for it. 

The treatment here recommended, is to be adopted in the 
higher, and more violent grades of fever. Such fevers occur 
most frequently, early in the season. In some cases, espe- 
cially at a later period, some patients seem unable to bear 
the active remedies mentioned. I have seen jalap, or antimo- 
nial powder, operate like a cholera morbus, and threaten the 
life of the patient. For fear of meeting these cases, let every 
patient, in bilious fever, have in his room, opium or laudanum. 
If his remedies, or his disease produce the excessive dis- 
charges I have mentioned, give laudanum to arrest it without 
delay. 

The active and depleting remedies used in this disease, are 
exceedingly useful in lessening its force, and hindering the in- 
jury of important organs, which so often remain diseased for 
along time. I think I can say from experience, that relapses, 
and chronic diseases of the spleen and liver, are more liable to 
happen where the cure has been attempted with quinine alone. 
Let these remedies for evacuating the vicious contents of the 
bowels, and moderating the fever, be still adhered to. Use 
them in moderation, but do not forget, that no extent to which 
they can be carried, in anyone paroxysm, can be expected to 
terminate the disease. On the contrary, their excessive ac- 
tion, especially on the days of remission, are hurtful. And 



BILIOUS REMITTING FEVER. 127 

let the practioner still remember that when the disease has 
passed its highest point, and the patient has borne it seven or 
eight days, he neither requires, nor can well bear, active de- 
pletion. 

Quinine, on the contrary, is to be given as a specific, in this 
disease. It is to be given when the fever is lowest ; but in 
congestive cases, where the remissions and exacerbations are 
less noticed, it is to be pressed the more. The length of time, 
to which its use may be extended, cannot well be defined. — 
Ten grains a clay may be taken, for man}' successive days. — 
Twenty or thirty grains a day, will, in a few days, produce 
great prostration. It is a mistake to call quinine a tonic. 

RECAPITULATION OF REMEDIES. 

In the first place, it is to be borne in mind, that bilious fe- 
ver is a disease of paroxysms and remissions, and that in dif- 
ferent cases, the symptoms and the remedies, differ as widely 
as can well be conceived. It is therefore necessary to be 
watchful of the symptoms and stage of the disease, and use 
the remedies as they are advised. The cases most frequently 
met with, are of a medium grade, and can be treated with en- 
tire success. They are characterised, by a light chill, follow- 
ed by a high fever, with full pulse, flushed face, restlessness, 
pain in the head, back, and limbs, with nausea or vomiting ; 
during the chill, and sometimes through the paroxysm. The 
fever declines, or goes nearly off, and for some hours the pa- 
tient seems almost well. I have pointed out the remedies 
which I use, in each day of such an attack of fever, and advise 
them with such variation as the case may require. 

1. Remedies for the first day of bilious fever. It is seldom that a 
remedy is demanded by a patient, on the first day of the at- 
tack. The light fever, which frequently comes on at night, 
without any chill, is disregarded. But if the symptoms are 
stronger, and the fever considerable, ten grains of calomel 
should be given without delay. Six hours afterwards, or early 
the next morning, give seidlitz powders, one every hour, till 
the bowels are moved. 

2. Second day. The calomel wmich has been advised for the 
first day, may, if it has been neglected, be given on the sec- 
ond. But if too much time has elapsed, to allow of its opera- 
ting, before the expected rise of the fever, let no seidlitz pow- 
der or castor oil follow it, but give quinine. Divide ten grains 
of quinine into four doses — commence in the forenoon, and 



128 BILIOUS REMITTING FEVER. 

give one hourly till the four are taken. Nothing more is to 
be given till the next day. 

3. Third day. Recollect the manner in which the days are 
counted in this disease. If the attack is on Sunday, or Sun- 
day night, the third day is Tuesday. This is the day, on 
which a powerful attack will happen, and it will come on with 
more or less chill. But the morning of the third day presents 
an opportunity, in some cases, of a profitable use of quinine. 
If the fever is off, or nearly so, at four o'clock in the morning, 
or later, commence with quinine, and give two grains hourly 
till ten or twelve grains are administered. Give nothing more 
till the next fever has risen. 

As soon as the chill has passed off, and the fever is found to 
be high, take two drachms of nitre, and two grains of tartar 
emetic, and mix them in half a pint of water. Give a table 
spoonful of this mixture every half hour, if you desire it to ope- 
rate as a powerful emetic; but if you wish a milder operation, 
give it at longer intervals, say, from one to two or three hours. 
This is a powerful remedy, and always to be watched in its 
operation. If it proves too violent, and the patient seems to 
fail under it, check it with laudanum, from twenty to sixty 
drops, according to circumstauces. If the patient is delicate, 
and has, on former occasions been found to sink under drastic 
medicines, do not use the tartar emetic, but in its place put 
thirty grains of ipecac. This will form a mixture of great 
power, and should be used especially with infant patients. — 
The emetic mixture should be continued through the fever, in 
such quantity as can be borne without too much vomiting, or 
till it operates as a cathartic. 

If the fever has proved violent, or the medicine has operated 
freely as a cathartic, give laudanum, Where the fever mix- 
ture operates several times as a cathartic, and the fever is on 
the decline, a powerful dose of laudanum should be adminis- 
tered. But if the paroxysm has been violent, the laudanum 
is by no means to be omitted, whether the medicine has opera- 
ted as a cathartic or not. Give from thirty, to sixty, or eighty 
drops according to circumstances. If there is a charm in medi- 
cine, it will be acknowledged by the patient, who has strug- 
gled for hours with a violent paroxysm of fever, and on its de- 
cline, takes a full dose of laudanum. 

During this paroxysm of fever, the free administration of 
cold water and cool air is allowable. Where there is great 
heat, a free affusion of cold water may be kept up for hours 
together if necessary. 



BILIOUS REMITTING FEVER. 129 

4. Fourth day. This day, if the attack was on Sunday, will 
be Wednesday. It is a day of remission, and every way suit- 
ed to the administration of quinine. From ten to twenty 
grains may be given in the course of the day. Commence in 
the morning, and give two grains hourly, till the quantity in- 
tended to be given, is administered. In common cases I think 
ten grains a sufficient quantity, but if the strength of the pa- 
tient has failed greatly in the previous paroxysm, I should 
enlarge the quantity to sixteen or twenty grains, according to 
the opinion I had of the case. The night of the fourth day, 
will be calm and comfortable, if the disease is already sub- 
dued, but if the next day is to appear with violent symptoms, 
there will be no rest for the patient on the fourth night. Leave 
with him a dose of calomel, say ten or fifteen grains, and if 
he cannot rest, or has fever at ten o'clock at night, let him take 
the calomel. 

5. Fifth day. This is a day of danger in violent cases. — 
Begin early with quinine. If the fever of the previous night 
subsides, begin at four o'clock in the morning — if there is too 
much fever at that hour, wait till it gets lower, and it will hard- 
ly fail to do so in two or three hours. As soon as this remedy 
can be given without the presence of too much fever, give 
doses of two or three grains every hour, till from twelve to 
twenty grains are given. The quantity to be given, should be 
larger as the patient may have been more prostrated in the 
fever of the third day. 

But whether the quinine is administered or not, a light chill, 
and violent fever, may be expected ; and if it occurs during 
the administration of the quinine, stop that remedy at once. — 
As soon as the heat is generally diffused, and the purple hue 
and cold fingers of the chill, have gone off, begin with the an- 
timonial mixture. Take two drachms of nitre, and two grains 
of tartar emetic, and dissolve them in half a pint of water. — 
Give a table spoonful every half hour for an emetic, or once in 
one or two hours to produce a lighter effect. If the patient is 
strong, and has not taken much active medicine, give it to ope- 
rate actively ; and if the fever continues five or six hours after 
the vomiting ceases, begin again, and give it in less doses at 
longer intervals. This fever of the fifth day, is to be contend- 
ed against to the last. A. still stronger remedy will be made, 
by taking twenty grains of calomel, one drachm of nitre, and 
two grains of tartar emetic, rubbing all together, and dividing 
the whole into eight powders. Give one of these powders 
every two hours, till they operate actively. The heat is, at the 
9 






130 BILIOUS REMITTING FEVER. 

same time, to be kept down by the most- effective application 
of cold air and cold water. These remedies will be as grateful 
as they are valuable. These are the most active remedies 
which I use in keeping down the violence of fever, on this, its 
highest day. They are to be used according to the strength 
of the patient, and violence of the disease. They are to be 
pressed hard on the rise, and lightly on the decline, of the fe 
ver ; and if there is doubt of the ability of the patient to bear 
these remedies, leave out or lessen the proportion of tartar emet 
ic. If the discharges, by vomiting or by stool, are copious 
stop this remedy at once. 

And now at the close of the paroxysm of the fifth day, d 
not forget to give a full dose of laudanum or morphine. If the 
case is alarming, and. the patient seems to have more to encoun- 
ter than he can bear, give a tea spoonful of laudanum at a dose. 
If the case is lighter, give less, even twenty or thirty drops. This 
remedy ought not to be given till the fever is manifestly on the 
decline : commonly it will be evening before it is demanded; 
but if the medicines operate very actively, especially, if they 
produce cramp and pain, this remedy may be given earlier. — 
During the administration of these powerful remedies, the pa- 
tient is to be closely watched, and if his strength seems to fail, 
give laudanum to check the operation of the remedies, and 
brandy and other stimulants should they seem necessary. But 
with common prudence, these measures w 7 illbe uncalled for. — 
The treatment of the first five days of bilious fever, is a guide 
to all the days which may succeed. The same remedies, un- 
der the same circumstances, will be required ; and it is only 
necessary, to be guarded against giving remedies which are 
too active, when the strength of the patient declines. As the 
disease approaches a close, the tartar emetic, calomel, nitre, and 
other depleting remedies, will be less called for ; but the quinine, 
laudanum, and brandy, will be more required. I will only say, 
that the — 

6. Sixth day, Requires the same treatment as the fourth ; 
but it is to be recollected, that now the disease ought to give 
way, and evacuants should be, sparingly, if at all used. 

1. Seventh day. If the fever returns on this day, it will be 
high, and may be dangerous, although a patient who has lived 
to the seventh day, ought not to die of bilious fever. But if 
the fever proves high, use the remedies recommended on the 
fifth day. Only give them with less activity, quit them ear- 
lier, and by no means forget the great remedy, laudadum, at 
the decline of the paroxysm. On this, seventh day, tartar emet- 



BILIOUS REMITTING FEVER. 131 

ic will hardly be necessary, but a free use of cold affusion 
will come in very appropriately. More watchfulness over the 
strength of the patient, will be necessary on this day. A ra- 
pid crisis may throw him into a cold perspiration, and require 
the strongest doses of laudanum and brand}'' for his support. — 
If in such an extremity, a profuse perspiration continues after 
the use of laudanum and brandy, let the skin be rubbed dry, 
and the warmth kept up in every way. Sinapisms, blisters, 
and stimulating liniments, have been much used at this period 
of fever. A bath of pepper tea, followed by dry friction, is, in 
my opinion, the best treatment. 

8. Eighth day. The remedies of the fourth day, are good for 
the eighth. They are to be used with a lessened force, ac- 
cording to the period of the disease. 

9. Ninth day. This day resembles the seventh ; and, in times 
past, was regarded as a great crisis. If the disease has been 
properly treated, it will hardly be felt on the ninth day. But 
if the fever comes on, use in moderation the remedies recom- 
mended on the seventh. 

It seems useless to say more, on the remedies for this dis- 
ease, when its course is regular. The paroxysms are not regu- 
lar after the eleventh day. 

But there are other forms of bilious fever, and it is our 
next object to point out the remedies, in some of these. 

1. Congestive fever. This has been called an obscure, or illy 
defined state of the system. It is marked by a pallid or taw- 
ny color of the face, purple nails and hands, low pulse, and 
sometimes agonizing pains, and distress about the stomach 
and bowels. These symptoms occur in the middle and highest 
stage of the disease. 

These symptoms are alarming, on their very face. Give 
opium, three grains, and calomel fifteen or twenty grains, with- 
out delay. If the extremities are cold, use warmth, by means 
of hot bricks, and if the symptoms continue, apply mustard, 
or cayenne pepper, extensively to the skin. If these symp- 
toms continue for many hours, give camphor and opium. — 
Take spirit of camphor and laudanum in equal parts, and mix 
them in a vial. Give thirty drops of this, from time to time. 
By these remedies, ease and quiet will be obtained, and the 
patient pass on to a remission on the next day. The next 
remedy is quinine. Of late, it is recommended without meas- 
ure, or regard to time. I recommend it with more delibera- 
tion, and in less quantity. If the congestive symptoms appear 
on the third day, I give quinine on the fourth, and afterwards 



132 BILIOUS REMITTING FEVER. 






in the same manner, as in other cases. Let the remedy be 
given with great freedom. Take thirty grains of quinine, and 
make it into eight pills or doses. Give one hourly, till all are 
taken. If the symptoms of congestion appear again, give the 
opium and calomel again ; and on the next day if a free opera- 
tion from the calomel does not take place, give castor oil, and 
follow with laudanum, if there is great weakness. But do not 
lose a day in giving quinine. If there is a morning remission, 
on the worst day, give quinine in the morning, and on the next 
dav, give of this remedy freely. 

Quinine and laudanum are the great remedies for congestive 
fever. 

2. Bilious fiver ivith Cholera. When bilious fever is attended 
with the symptoms of cholera morbus, and on the rise of fever, 
there are copious discharges from the stomach by vomiting, 
no attempt is to be made to arrest these symptoms, on their 
first occurrence. The disease is to be allowed its course, till 
thorough and copious evacuations have taken place. This will 
commonly take place in three or four hours, by which time the 
patent will be very much exhausted. At this time a full dose 
of laudanum should be given; from sixty drops to a tea spoon- 
ful. This will probably arrest the vomiting, and suppress the 
discharges from the bowels. But if, in the course of two hours, 
the patient obtains no relief, the laudanum in small doses is to 
be repeated. If the prostration is extreme, and appears to be 
dangerous, brandy is to be added, with sinapisms over the pit 
of the stomach. These remedies will almost certainly bring 
the disease to a favorable remission. The patient will proba- 
bly pass the night in comfort, and on the next morning be 
found a great deal better. He is now in a favorable state for 
the use of quinine, and should take a pill, containing two 
grains, every hour, till six or eight have been taken. Every 
paroxysm is to be treated in the same way ; no remedv be- 
side the quinine and the laudanum, will be required ; the case 
will probably terminate in five or seven days, and the recov- 
ery will be perfect. 

3. Bilious fiver with Coma. Recollect that coma is a state of 
profound sleep, from which the patient can scarcely be arous- 
ed. When this state occurs on the third, or fifth day of fever, 
the patient should be bled to the extent of sixteen ounces. 
This should be done in the rising stage of the fever, or it had 
better be omitted. Where I have thought such cases not 
very dangerous, I have omitted the bleeding altogether. But 
whether the bleeding has been practised or not, a free and ex- 



BILIOUS REMITTING FEVER. 133 

ensive application of cold water should be made. The pa- 
ient should be placed on a cot, or maltrass, exposed freely to 
he air, and cold water constantly applied over the bodv and 
extremities, till the coma begins to pass off. I have seen pa- 
rents aroused by these means from the deepest coma, in half 
in hour; but should it require a greater time, the use of the 
•emedy should be persisted in. As soon as the patient is suf- 
icientlv restored, a dose of calomel, from ten to fifteen grains, 
s to be given. This remedy is to be followed in four or five 
lours, with Seidlitz powders ; for it is important that a full ca- 
bartic effect should be brought about speedily. If the heat is 
^reatand the symptoms violent, the antimonial mixture may be 
»iven instead of the seidlitz powders. A table spoonful of the 
mixture may be given every hour or two, till it operates ac- 
dvelv. In this way, the paroxysm of fever will be brought to 
a close, and if his remedies have operated very actively, a 
Jose of laudanum should be given. The next day, he should 
take quinine in doses of two grains, hourly, till twelve or fif- 
teen mains are administered. The next day, which is the pe- 
riod of the greater paroxysm, should be improved by the early 
use of quinine. Begin at four o'clock in the morning, and give 
rom two to three grains every hour, till the quantity designed 
for the day is administered. In this way, the comatose stale of 
fever is to be treated, till it is brought to a close. I have not 
found the disease, in this form, attended with much danger. 

4. Convulsions. This is a very embarrassing symptom of 
never. It is principally met with in children, and occurs in the 
cold, as well as the hot stage. Warm bathing has been much 
used in these cases. I think this remedy can seldom be used 
beneficially. It would be injurious in the hot stage, and when 
the convulsions take place during the chill, the hot stage is al- 
most immediately bi ought on. Convulsions common!}' pro- 
duce coma, and require the same remedies for the removal of 
this symptom, which have been recommended above. But 
convulsions sometimes have intervals, in which it is practica- 
ble to administer remedies. When this can be done, give an- 
timonial mixture, promptly, so as to operate as an emetic. 
This will probably terminate the convulsions, and the case- 
will pass on to a regular remission. During this remission, 
and up to the next paroxysm, quinine is to be given in the same 
manner, as it is in the remissions of other forms of fever. In 
this manner, convulsions in bilious fever are to be treated, from 
period to period, till the case terminates. 

5. Gastric fever. In these cases, bilious fever seems to attack 



134 BILIOUS REMITTING FEVER. 

the stomach alone, sometimes with intolerable thirst, and the 
instant rejection of every thing taken in to the stomach; but 
in other instances, there is only an eructation, or belching up 
of bilious matter. These cases are exceedingly dangerous. 
They are to be arrested by opium, camphor, and quinine. As 
soon as the symptoms we have mentioned, are manifest, give 
from eighty, to one hundred drops of laudanum. If this does 
not afford relief, take of opium six grains, camphor forty 
grains ; rub them together, and make twenty-four pills. Give 
one of these pills hourly, or two every two hours, till the vom- 
iting ceases. As soon as the stomach will retain it, give qui- 
nine. This remedy, may, in these cases, be administered at the 
rate of about twenty grains a day. The paroxysms of the 
fever will not be very distinct, and the opium and camphor, 
and the quinine, are to be used, from day to day, till the case 
terminates. No emetic or cathartic should be given in these 
cases. 

6. Nettlerash or Urticaria. When this symptom occurs in 
bilious fever, it controls the remedies which are to be used, 
If the oppression is great, with difficult breathing, and great 
irritation on the skin, give three grains of opium, and fifteen 
grains of calomel, at a single dose. Warm drinks, and 
warmth applied to the skin, are to be urged on the patient, 
though he be suffering with intolerable heat and thirst. He 
will obtain relief, as soon as a free perspiration takes place. 
When the paroxysm has passed, if the calomel operates of 
itself, give no other cathartic ; but if it does not operate, give a 
light dose of castor oil. These cases are exceedingly distres- 
sing, but, under this mode of treatment, not dangerous. The 
paroxysm will subside in due time, and its return may be pre- 
vented by the use of quinine, given in the manner I have again 
and again pointed out. 

7. Hemorrhage in bilious fever. Vomiting blood, or passing 
by the bowels, large quantities of blood, are exciting and 
alarming symptoms. They admit of very little variety in 
practice. The affusion of cold water on the body and ex- 
tremities, will be proper at first ; but the great remedy is a 
combination of sugar of lead and opium. Take of sugar of 
lead six grains, opium three grains, and give the whole at once. 
If the disease goes on, and the discharges of blood continue, 
repeat the dose, or give a smaller dose of the same kind. If the 
patient becomes much exhausted, stop the cold bathing, and 
rely on the opium and sugar of lead, to the last extremity. 
Doubts are of late raised, as to the power of sugar of lead in 



BILIOUS REMITTING FEVER. 135 

suppressing hemorrhage ; but having used it in such cases as 
I have discribed, for many years, and never having failed in 
seeing the disease give may, I should not now change it for any 
other remedy. I never gave more than eight grains of sugar 
of lead, in one day, in such cases, and commonly three grains 
are sufficient. 

When the paroxysm is over, and the next, or well day has 
arrived, give quinine, in the usual manner, to prevent the re- 
currence of the disease. 

7. Protracted cases. By this term, I mean cases which 
run on beyond the eleventh day, and assume a milder form ; 
but with no interval in which the fever is entirely off'. They still, 
however, have their paroxysms and remissions, and are much 
more common in children than in grown persons. In these cases, 
the heat of the skin is to be kept down by the free application 
of cold water. This remedy, is to be continued, according to 
the violence of the fever, and strength of the patient. It is 
not to be continued too long, where there is great weakness. 
It may be repeated, from time to time, while the symptoms de- 
mand it. In some cases the pulse becomes very strong, and 
the face much flushed. In these, the antimonial mixture 
may be given, in small doses at long intervals, so as not to ex- 
cite vomiting. It must not be forgotten that the patient is 
much exhausted, however hard the pulse may beat. When 
the antimonial mixture has been used for some hours, and the 
fever is on the decline, give a moderate dose of laudanum. If 
the bowels are costive, calomel is the best cathartic, and is to 
be given as often as it is thought necessary. 

But, in these cases, the great remedy, quinine, is never to be 
lost sight of. It should be given when there is least fever, 
every day, or every second day, as the case may seem to ad- 
mit. My plan is, to divide what quinine I intend to give in the 
course of the day, into four, or six doses, and give one hourly, 
till all are taken. Doses of two grains each, will be a com- 
mon allowance. This remedy should not be pressed for many 
days together. Used in that way, it produces great debility, 
with nervous agitation. Use it a few days vigorously- and 
then allow time for the patient to recover from its effects. 

8. Disorders following bilious fever. It may be observed, that 
bilious fever is not so apt to produce long continuing disor- 
ders, as the common ague and fever. These disorders are, how- 
ever, much the same, whatever may have been the form of the 
fever, from which they have arisen. I think it only necessary 
to mention three of these disorders here. These are, inflam- 



136 BILIOUS REMITTING FEVER. 

mation of the spleen, inflammation of the liver, and diarrhoea. 
The inflammation of the liver and spleen, when produced by 
bilious fever, are mere chronic inflammations of these organs. 
They are to be treated with grain doses of calomel, given 
twice, or three times a day, till a very slight salivation is brought 
on — antimonial mixture, given m broken doses for a few hours 
at a time, when the fever and heat are high, and moderate 
bleedings, from time to time, as the strength of the patient will 
bear it. Bloodletting is by far the most valuable of these 
remedies, and is allowable, even where there is a great degree 
of debility. The blood should be drawn in small quantity at a 
time, and repeated according to circumstances. Leeches and 
cupping will find their proper place in some of these cases, 
and blisters are often very beneficial. These remedies should 
not be crowded on the patient too rapidly in succession, or too 
many at a time. Recollect that the disorders are chronic, and 
must be treated for a length of time. The diarrhoea, which 
sometimes follows bilious fever, is a more formidable disease. 
It is attended with considerable fever, and this fever seems to 
occur in paroxysms. The discharges from the bowels seem 
also to occur in paroxysms ; they occur principally at night, 
and are very copious. To arrest these discharges, give a dose 
of calomel and opium — two grains of opium with eight or ten 
grains of calomel. This remedy may become necessary, again 
and again, but the quantity of the calomel should be lessened, 
from time to time, so as not to act on the bowels as a cathartic. 
I have seen but little benefit in this species of diarrhoea, from 
the use of astringent medicines ; but I have used blisters with 
considerable advantage. Bloodletting is sometimes a good 
remedy in this disorder. It may be observed, that of all the 
forms of diarrhoea which I have seen, this presents the strong- 
est pulse and the hottest skin ; it is truly an inflammatory dis- 
ease. These symptoms induced me to try the effect of mode- 
rate bleeding, and I commend the practice to the attention of 
others. Calomel is not so beneficial as could be wished, in 
these cases. 

In all the disorders which follow bilious fever, quinine has, of 
late, been extolled as the first remedy. I have no doubt of 
its great power over these disorders. I cannot say that I have 
had much experience of its use in these cases, for I have of 
late years very rarely met them. I should not hesitate, how- 
ever, to give this article a fair trial, should an opportunity oc- 
cur. _ The quinine should be so given as to make a strong im- 
pression on the system, on that part of the day in which the 



INTERMITTENT FEVER. 137 

patient is expected to have the least fever. Take, for instance, 
sixteen grains of quinine, divide it into four doses, and give 
one hourly till the four are taken. This may be repeated, 
from day to day, for three or four days. It is then to be sus- 
pended for a few days; after which if its effect has appeared 
to be beneficial, it may again be repeated in the same way. 

And now, that 1 am to take leave of the subject of bilious 
fever, I cannot stop without a word to the remote, and seclud- 
ed sufferer who may take this fatal disease, where the counsel 
of no physician can be obtained. I have set forth remedies 
for his relief in the plainest manner that I can. Common 
sense, and common judgement, will enable him to judge for 
himself, or his friends may aid him in it. He may find him- 
self affected in a manner I have not pointed out; for the symp- 
toms of the disease in various cases are without number. 
Yet there will be enough of the symptoms I have mentioned, 
to shew the nature of the disease. The remedies must be 
used according to the symptoms, and stage of the disease. 
Great changes happen in a few hours, by the natural course of 
the disorder. Learn to expect these changes, at the rise and 
decline of the fever, and take good notice of their times of re- 
turn. Where there are regular remissions, the great remedy 
quinine may be safely relied on. Where these remissions are 
less distinct, shorter, or not to be seen, the case is in due pro- 
portion worse. Still quinine is to be used in large doses at 
some time every day. Quinine is the great remedy. 



INTERMITTENT FEVER. 

I have attributed to the unproved substance malaria, the 
production of yellow fever, and bilious remitting fever, and 
have no other cause to which I can attribute intermittent fever. 
The facts which sustain a belief in the existence of malaria, 
have been, to some extent, detailed in what was said of bilious 
fever. They are the same in relation to intermittent fever, 
and need not be repeated here. It may seem strange to at- 
tribute to the same cause, the highest grade of yellow fever, 
and bilious fever, and the lightest forms of intermittents ; but 
with the best view I have been enabled to take of the whole 
subject, I cannot do otherwise. The cause, whatever it is, 
seems to be most powerful, on the sea coast, of the hottest 
districts of tropical countries, next, in the low districts, and 
great fresh water river valleys of temperate climates ; and it 



13S INTERMITTENT FEVER. 

gradually declines, and disappears as we approach the arctic 
ciicles. The fever which arises from this cause, when in its 
greatest force, is continued ; that which arises from the next 
degree is remittent ; and that which arises from the least, is 
intermittent. These forms of fever run so insensibly into each 
other, that it is, in many cases, impracticable to discriminate 
between them ; but they do not differ more than the brook and 
the river, the bush and the tree, the child and the man. The 
breadth, variety and magnitude of the subject, require that it 
should be treated of in separate parts ; but in their origin and 
tendency, these varieties of fevers are the same. 

We have described the highest forms of malarious fever, 
and have witnessed their frightful symptoms and destructive 
course ; and turn with pleasure to the mild intermittent, whose 
familiar acquaintance, it has been our fortune to make. Nor 
do we doubt finding this a field more instructive, as well as 
more agreeable, than that we have occupied. This will ap- 
pear reasonable, when it is considered, that yellow fever is the 
effect of the concentrated action of the mysterious poison ma- 
laria; and that its destructive force is gathered, as it were, into 
a short, but fatal paroxysm. By this rapid course, its effects 
and tendencies are studied with less advantage. The same 
difficulty, in a less degree, presents itself to the student of 
bilious fever. But in the mild intermittent, there is nothing 
to hinder the most patient investigation. The disease threat- 
ens little danger, and offers ample time. 

The intermittent is the true form of the malarious fever. 
Before this the constitution can sustain itself, and the tenden- 
cy of the disease discloses itself as time rolls on. I shall be 
compelled to limit myself to a few remarks. 

The first observation I offer, is, that intermittent, or ague and 
fever, never occurs, except from exposure to the poison of 
malaria. This is disputed by names of high authority. I ad- 
here to it, because I believe there is no well attested example 
ot a fever, of this type, originating in winter, or from any ac- 
cidental cause. And if the cases which are adduced, must be 
regarded as intermittents, it is easier for me to believe that the 
malarious origin of such cases has been overlooked, than to 
give up the facts I have witnessed, tending to prove this fact. 
I have had before me, for thirty years, a field of facts con- 
firming the opinion, that intermittent fever never arises from 
accidental causes. A great part of the country around Mil- 
ledgeville, is totally free from malaria. The people who re- 
side on these favored localities, never have chill and fever. I 



INTERMITTENT FEVER. 139 

know hundreds of them, and have witnessed their progress 
from youth to age, and can say, from my own knowledge, that 
they never are affected with intermittents. And I know, with 
equal personal knowledge, that their neighbors who are less 
favorably located, do not escape attacks of intermittent. Nor 
do these favorable and unfavorable localities, lie a great dis- 
tance apart. The difference between places within two hun- 
dred yards, is sometimes very great ; and I have seen it obvi- 
ous on different sides of a street, in a village. The difference 
which I aver to exist between a place free from malaria, and 
another, in which it exists, though separated but a few rods, 
is, that in one, a majority of persons will be affected with in- 
termittents ; and in the other, not one, though a thousand per- 
sons might reside in it. This statement is no stronger than 
the facts I have annually witnessed warrant. They are, in 
my mind, conclusive; and prove that the cause of intermittent 
fever, is a poison in the place, or in the atmosphere, and that 
it is limited to certain localities. 

The next remark I wish to enforce is, that intermittent fever 
always originates in the heat of summer or autumn. This 
fact establishes a closer relation between all the malarious fe- 
vers, than has heretofore been supposed to exist. The cause 
of the whole of them, arises only in hot weather. I know that 
writers describe intermittents of spring, and I have seen many 
such ; but these occur only in yersons who have had a, yellow fever, 
a bilious fever, or a,n intermittent fever, the previous year I They 
are therefore not new cases, but relapses. This remark I 
made more than twenty years ago. Since then I have care- 
fully noted all the intermittents of spring, which have come 
under my notice. They have been exclusively confined to 
such as have had the disease, in some form, during the pre- 
vious fall or summer. I have seen two cases in which the dis- 
ease recurred, after being apparently cured for eighteen months. 
If this fact is deemed of any consequence, let its establish- 
ment rest on future observation. Enquire of such patients, if 
they have not had the disease the previous year; and do not 
too readily credit their statement to the contrary. Many per- 
sons have, on the first enquiry, denied having had any disease 
of the kind ; who have afterwards informed me that their 
memories had been at fault, and that they had, the year before, 
suffered a similar attack. The length of time which this poi- 
son, when once received into the system, may remain unob- 
served, or inactive, has not been ascertained. It is equally 
uncertain how long after the suspension of chills and fevers, 



140 INTERMITTENT FEVER. 

the disease may be renewed, and go on, as if it had not been 
suspended. I have seen hundreds of cases, in which the sus- 
pension had been six months ; and many in which it had been 
eight or nine. It is uncertain whether a person, who once has 
intermittent fever from exposure to malaria, ever gets so free 
from the poison, as not to be subject to renewed attacks, from 
accidental causes. 

The next remark I offer is, that in the highest grade of ma- 
larious fever, the chill is slight or imperceptible ; but in the 
lowest, it becomes more conspicuous, and lengthy. It is in- 
structive to observe the chill,, scarcely perceptible in yellow 
fever ; slight, but punctual to its time, in bilious fever ; and so 
violent in the quartan-ague, as to be the principal object of 
fear to the patient. Seeing that the most violent chills, attend 
the cases of least danger, it has been inferred that the chill is 
curative, and beneficial to the patient. This may be true, in 
reference to the present disease ; but it can seldom be bene- 
ficial to contract an ague and fever. Let him who has never 
had it, take care and avoid exposure to its causes. 

Intermittent fever has been divided into varieties, corres- 
ponding with its periods or time of continuance, from the be- 
ginning of one paroxysm to the begining of another. Those 
which recur once a day, have been called quotidians; these 
which return on alternate days, at a full period of forty-eight 
hours, tertians ; and those which return, after a full period of 
three days, or seventy-two hours, have been termed quartans. 
These terms, as I have suggested, are not strictly proper ; but 
may answer our purpose, if always used in the same sense. 
Common language, refusing to submit to an absurd nomencla- 
ture, is now so used as to correct these terms. A fever re- 
turning on alternate days, is termed a second day fever; and 
one returning after a lapse of three days, is called a third day 
level-, or more commonly, third day ague and fever. I shall 
endeavor to so use these terms as not to be misunderstood. 

These are not all the terms which have been used, to signify 
the length of the periods of this disease. Varieties and changes 
of times without number have been witnessed, in different ea- 
ses, and terms to correspond with these adopted. For in- 
stance, cases have occurred in which the chill has returned 
twice a day, twice every second day, twice two days in suc- 
cession, and not on the third day — once in six days, once in 
eight days, once in three weeks, and finally, a case is mention- 
ed in which the chill returned exactly once a year. The^e ir- 
regularities are strange and unaccounted for, but they need not 



INTERMITTENT FEVER. 



141 



give us much concern ; they require no new rule of practice, 
no new remedy, nor do they signify greater danger. 

Many diseases make their appearance with chills ; but the 
character of the disease which follows, soon shews that they 
are not intermittent?. The interval of fever is so remarkable, 
and the punctual return of the chills so striking, that the in- 
termittent fever is less subject to be taken for another, than al- 
most any other disease. A great deal has been said of debility 
and pre-disposition, and I grant that these causes may render 
the attacks, of intermittents dangerous; but observation has 
satisfied me that neither age, sex, color nor condition, will pro- 
tect from attacks of this disease. Nor are the premonitory 
symptoms so obvious as some have made them. On the con- 
trary, I think a majority of original attacks come on in the 
highest health, without the slightest premonitory sign. 

We are unable to state the time which intervenes between 
exposure to the cause, and the attack of intermittent. It sel- 
dom occurs in less than eight days, and more frequently re- 
mains dormant for three weeks. There are cases related, in 
which the poison has remained dormant for a much greater 
time; but I have not witnessed them. Nor can I verify the 
statement, that the incubation, or dormant state of this poison 
in the system, is shorter in proportion to the violence of the 
disease it gives rise to. I have witnessed two cases of fatal 
yellow fever, which did not come on in less than twenty days, 
after the patients had left the malarious districts, in which 
they had been contracted; and I have, more than once, made 
the same remark of bilious fever. 

I have said that a bilious fever is a disease of paroxysms 
and remissions ; an intermittent is composed of paroxysms and 
intervals, or intermissions. This peculiarity of the disease is 
much more conspicuous in the chill and fever, than in the bil- 
ious fever. Three distinct stages mark the progress of inter- 
mittent — the chill — the fewer, or hot stage, and the intermis- 
sion. These compose a whole period, and may go on in suc- 
cessive rounds, for an indefinite time. Left to itself, I think it 
commonly continues three weeks; is then suspended for eight 
days, and returns again. Its progress, continuance, and 
changes, afterwards are entirely uncertain. Six months is not 
an uncommon length of time for its continuance. 



DESCRIPTION. 



A fit of ague is usually ushered in by a sense of weakness 
and oppression at the stomach. General lassitude follows, and 



142 INTERMITTENT FEVER. 

a sensation of cold, as of water trickling down the back, is felt 
suddenly and at intervals. The breathing becomes oppressed, 
and general coldness, with shrunken features, pale face and 
cold extremities occur. Tremor comes on, and sometimes 
amounts to a violent shaking of the body. Great coldness is 
complained of, and the patient seeks warmth by any available 
means. Buried in clothing and surrounded by hot applica- 
tions nearly burning, the patient still complains of cold. These 
symptoms gradually increase to a certain height, and then as 
gradually subside. The shaking ceases, the contraction and 
roughness of the surface disappear, the breathing is full and 
free, and fever supervenes. 

There is great variety in these symptoms, in different cases. 
A violent headache is complained of, and nausea and vomiting 
are not unfrequent. The pulse, feeble and oppressed, seems 
to yield to the impulses around it. The coldness complained 
of by the patient, is more apparent than real. Shrunken, 
shivering, and drawn up in his bed, his purple hand is taken 
hold of by his physician ; but is not much colder than in 
health. Under the clothing, especially about the body, the 
heat seems rather increased. The ends of the fingers and toes, 
the nose and tip of the ears, feel a little cold ; and that is about 
all, which such an examination can detect. The cold stage 
will continue for an uncertain period ; from half an hour to six 
hours. 

The cold stage is succeeded by the hot. This is the reverse 
of the former. The features are turgid, the pain in the head 
intense, the pulse full, and great heat and restlessness come 
on. Thirst, which was present in the cold stage, becomes 
greater now; the fever increases and the agony of the sufferer 
is extreme. 

The fever no sooner reaches its highest point, than it begins 
to decline. A warm dew of perspiration is seen on the fore- 
head ; the patient becomes quiet, the perspiration extends over 
the body and becomes profuse ; sleep comes on, and the fever 
subsides. The patient can arise from his bed, and is restored 
to apparent health. The skin is now dry, and the urine, which 
in the chill, was pale and watery, is now high colored and 
muddy, and deposites a thick sediment, resembling brick dust 
in color. This change in the urine, I have seen mentioned as 
the most decisive characteristic of the disease. I think every 
one of its features equally characteristic and certain. 

The remainder of the term of the disease, which is to last 
till the next chill, is spent in apparent health. But, in due 



INTERMITTENT FEVER. 143 

time, another chill comes on, and the same round of suffering 
is again to be gone through. 

No phenomenon in disease has excited so much of the won- 
der of physicians, as the regular progress of ague and fever, 
through its various stages. Volumes have been written, and 
theories of disease, and especially theories of fever, have been 
founded on it. These contrary, conflicting, and inconsistent 
essays, have convinced me, that the phenomenon is as little 
understood as ever. We know nothing of the nature of the 
cause of intermittent fever. 

A great deal has been said of the changes which intermit- 
tents undergo, in the course of their treatment. These chan- 
ges, as far as I have observed them, are almost always from 
the graver, to the milder forms. A continued, or yellow fever, 
may change to a remittent or bilious, and this last, to a chill 
and fever. In like manner, the types of intermittent change to 
the milder forms; a quotidian or daily chill to one on alter- 
nate days ; and this to one paroxysm in three days. A change 
of this kind, is an improvement in the condition of the patient. 
I am apprised that others have reported a different experience ; 
and that it is the received opinion, that cases frequently begin 
intermittents, run into remittents, and these again, into con- 
tinued or yellow fever. This opinion, I think, is erroneous. 
If a case commences intermittent, it continues of the same, or 
a milder type ; and where they have been thought to change 
to the higher grade of fever, the case, at the outset, has been 
mistaken. This fact, so far as it goes, tends to strengthen the 
opinion, that these forms of fever are essentially different. 
The whole subject is veiled in obscurity. 

TREATMENT. 

It would be interesting to follow this disease in its various 
forms ; but I think nothing further need be said, to enable the 
reader to recognise it, and to discriminate between it and eve- 
ry other disease. Nor do the changes of type, or period, ma- 
terially alter the mode of treatment. Under the operation of 
the remedies now used, it is hardly thought possible for a per- 
son to die of ague and fever ; but it may be well to remember, 
that a daily paroxysm of fever, twelve hours in length, is a 
more serious disease than a quartan ague, in which the patient 
passes two days out of three, without any sign of disease. 

There is seldom much difficulty in arresting chills, but they 
are prone to return ; and, on the whole, it must be acknovvl- 



144 INTERMITTENT FEVER. 

edged, that, when it is arrested at the first trial, it is far from 
being certain, that the patient is cured. Still, it is proper to 
give remedies immediately ; for the chance of escaping a re- 
lapse, is greater in proportion to the promptness, with which 
the disease has been arrested. 

During the cold stage. The chill announces the attack of the 
first, as well as every succeeding paroxysm. During the cold 
stage, there is very little to be djne, for good or for ill. The 
patient will instinctively seek a quiet and warm place ; and 
should be allowed to enjoy it as well as he can. I do not ad- 
vise any remedy during this stage of intermittent fever. 

lam apprised, that many remedies have been recommend- 
ed during the cold stage. I will not detain the reader with a 
discussion of their merits. I will only state, that I object to 
them all ; from laudanum, camphor, cayenne pepper and al- 
cohol, to emetics and bloodletting. The slight and transient 
chill of a dangerous intermittent, scarcely admits of a remedy, 
till it will be past, and the lengthy chill of a quartan ague, 
seems but to prepare the way for a light and transient fever. 
Let the comfort of the patient be provided for, by all convenient 
methods of supplying warmth ; and there let the treatment, in 
the chill stage, stop. 

During the hot and sweating stage. The treatment of the hot 
stage, will require some more attention. As a general rule, I 
advise the same rest, and attention to the comfort of the pa- 
tient in the hot stage, that has been recommended in the cold. 
Cases of a higher grade and more danger, require a different 
course. It is therefore important to know the cases in which 
danger may be apprehended. Where there is no alarming de- 
bility, or great personal defect in the patient, no danger need be 
apprehended from the first paroxysm. It may therefore be 
allowed to go on, to its own proper termination, undisturbed. 
Eut it is always, to some extent, uncertain, during the first 
paroxysm, what length of time may intervene before the next ; 
or, what grade or type the disease may assume. Writers say, 
that a chill occurring in the morning, gives reason to expect its 
return daily ; a chill at noon, on alternate days ; and a chill I 
in the evening, after the lapse of three days, or seventy-two 
hours. Now the danger is in inverse proportion to the chill. 
If, therefore, the chill is violent, and especially, if it makes its 
first assault in the evening, no remedy, during the ensuing 
fever, will be required. If, on the contrary, the chill is slight, 
and the fever which follows it high, it gives good grounds to 



INTERMITTENT FEVER. 145 

apprehend, that it may turn out an attack of bilious fever ; and 
no time should be lost in administering a proper remedy. 

I have no hesitation in the choice of a remedy, in the hot 
sta°;e of a first paroxysm of fever. Take of calomel ten grains, 
and give it at once, in pills or powder. Then take of tartar- 
ised antimony, two grains, and nitrate of potash two drachms, 
and dissolve in half a pint of water. Give a table spoonful 
every two hours. If it operates as an emetic, stop ; and ex- 
pect a full cathartic operation on the decline of the fever. 
Should this not occur, give a seidlitz powder, or a dose of cas- 
tor oil. If the operation of the medicine is prompt, and the 
discharges copious, give sixty drops of laudanum ; and the 
paroxysm will close, with great relief and comfort to the pa- 
tient. Nothing further will be necessary in this paroxysm, du- 
ring the hot stage ; but the remedies may be varied to corres- 
pond with the requirements of the case. If the patient is deli- 
cate, and fears the operation of the antimonial, give the calo- 
mel alone, and close with the castor oil as above. If there is 
great nausea, and the patient feeble, an emetic of ipecac may 
be given. But, of whatever kind, or in whatever mode, the 
emetic or cathartic may be administered ; give, at the close, 
the dose of laudanum as recommended. If the pain in the 
head is acute, and the heat of the body great, let affusions of 
cold water be made to the head, face, and limbs. This may 
be discontinued when the laudanum is given. 

It has been customary to divide the hot part of the parox- 
ysm, into a hot, and a sweating stage. This division is use- 
less, and in some cases, pernicious. The sweating stage is 
not always a mere close of the hot stage. When it is so, no 
remedy will be required in it. But, in many cases, the perspi- 
ration breaks out with the rise of fever, and continues, pro- 
fusely, during the whole of its term. These are often parox- 
ysms of great severity, and should be met with the effective 
remedies above recommended. Let it be particularly noticed, 
that the affusion of cold water, is as useful in these, as in any 
other cases. 

Such is the treatment I recommend, in the first paroxysm 
of intermittent fever. Should it be omitted in the first, it is 
equally applicable to the second ; or to any succeeding par- 
oxysm, where the strength of the patient, and violence of the 
disease, seem to demand active depletion. 

This active treatment is, by no means, to be repeated often- 
er than the symptoms require, and the strength of the patient 
allows. It will seldom be necessary to repeat it at all, and 
10 



146 INTERMITTENT FEVER. 

very rarely more than once. Bat when cases have continued 
for a great length of time, and an enlarged spleen and inflam- 
ed liver have come on, remedies of the active class are more 
necessary. Calomel becomes, in these cases, an important 
remedy. Give ten grains of it alone, at any time, and do not 
follow it up with any other cathartic. Let its operation be as 
gentle as it will, or even if it does not operate at all, give no 
cathartic after it. This mode of using calomel, will scarcely 
ever produce salivation ; and has in it an efficacy not to be 
found in other remedies. Calomel is a great remedy in all ma- 
larious diseases. 

It is in the intermission, that we have the opportunity of 
meeting and subduing, intermittent fever. The hot stage 
closes, and seems to turn over the patient, for a time, to his 
physician. Many remedies have been used during the inter- 
mission, with some degree of success; but they sink into in- 
significance, when compared with the great specific quinine. 
This is the great remedy for chill and fever. So fully and 
perfectly does it supply this great desideratum, that it is whol- 
ly unnecessary to detail a separate mode of treatment, for the 
several species of intermittent. Divide twenty grains of qui- 
nine into eight doses. This is a sufficient quantity to be giv- 
en, between one paroxysm and another, whether they come 
daily, or once in two or three days. If the chill is daily, com- 
mence as soon as the fever goes off, and so divide the time 
and remedy, as to finish it before the next chill is expected. 
The chill, in these cases, is apt to come in the morning ; and 
the medicine should be given through the night. It will an- 
swer, to begin six or eight hours before the chill, and give a 
dose hourly, so as to finish the twenty grains, before its time. 
But if the intermission is longer, commence earlier, and give 
the medicine at longer intervals. This is a very ample allow- 
ance of quinine for the worst case,"? of intermittent. It may 
be repeated, from time to time, till the chill is broken, and 
should then be suspended. Twenty grains daily of this reme- 
dy, is far from being a tonic or strengthening course. It pro- 
duces, on the contrary, tremor and debility ; but will, almost 
certainly, stop the chill, the first or second trial. 

When the chill comes on alternate days, the remedy should 
be administered a little differently. Divide the twenty grains 
into eight doses as before. Commence twenty four hours be- 
fore the expected chill, and give a dose, every hour, till four 
doses are taken. The remaining four doses may be retained, 
till within six hours of the attack. Then commence and give 



INTERMITTENT FEVER. 147 

a dose hourly, till the four are taken. The same rule holds 
good, where the chills come at longer intervals. Twenty-four 
hours are long enough for the administration of quinine before 
any chill, however long the interval, between one chill and 
another. 

When the disease does not readily give way, it has long 
been common to give some diffusible stimulant, an hour or two 
before the chill. Paregoric or laudanum is the best of these, 
and may be given in full doses ; say sixty drops of laudanum, 
two hours before the chill is expected. The various kinds of 
pepper, have been extensively used, since the publication of 
the Thompsonian system. I have tried them, and have not 
found them entitled to any preference over other, and less of- 
fensive stimulants. 

Having, by these means, arrested the chills, it becomes ne- 
cessary to take the best measures for hindering a relapse. 
These relapses are frequent, and, in some seasons, I have found 
them a great deal more frequent than in others. Their re- 
turns are not accidental, or always dependent on exposure to 
east winds, as some have supposed. They have their periods, 
and will return punctually, it not hindered by proper reme- 
dies. The periods at which there is reason to apprehend the 
i eturn of a chill, are the eighth, fifteenth, and twenty-second 
days, from the last chill. These days of return, are less cer- 
tain, than the regular returns of an unbroken chill; but, on a 
retrospect of many years' experience, I find that they are en- 
titled to be considered the days of relapse. 

The same means which will hinder the return of a chill at 
its regular time, will prevent the occurrence of a relapse on the 
eighth da} r . Take twenty grains of quinine, and divide it into 
eight doses; give four in the course of the seventh day, and 
four in the forenoon of the eighth. The same precaution may 
be used on the fourteenth and fifteenth, and on the twenty- 
first and twenty-second days. I have found this plan to suc- 
ceed as well as when the remedy had been continued during 
the whole week, succeeding the last chill. 

The quantity of quinine which I have recommended, has 
succeeded, in my hands, with few failures. 1 have found a 
less quantity ineffectual, and a larger unnecessary. Writers 
who have had to treat the disease in warmer climates, have 
found larger doses necessary ; and the mild form of the dis- 
ease, met in higher latitudes, has been successfully treated 
with half the quantity. Believing that there is some truth in 
these reports, I should recommend those who happen to be 



148 INTERMITTENT FEVER. 

attacked in a latitude lower than thirty-three degrees, to give 
larger doses than I have recommended; and those who find 
themselves in a higher latitude, to lessen the dose accordingly. 

Many remedies besides these, have been recommended for 
the cure of chills. There is but one, which I think entitled to 
notice here, and that is arsenic. The arsenical solution, or 
Fowler's solution of the dispensatories, is the form I most ap- 
prove. The dose, to an adult, is ten drops, two or three times 
a day. These doses may be gradually increased to twenty 
drops, if the chill does not give way, in four or five days. 
The remedy may be safely continued, for a week or more, if 
it produces no pain or sickness of the stomach. A dropsical 
swelling of the feet, is also a signal for suspending it. I have 
hesitated to mention this active and efficient remedy, because 
of its poisonous quality. Its value entitles it to a place even 
in a work like this. With a knowledge of its strength, it is not 
more dangerous than laudanum or tartar emetic. In intermit- 
tents, it has frequently succeeded where quinine has failed ; 
and being tasteless, is as easily administered to infants, as to 
grown persons. Relapses are thought to be less frequent af- 
ter its use, than when the disease has been checked by quinine. 

Many cases of ague and fever, present themselves in per- 
sons who have enlarged spleen, inflamed liver, disordered 
bowels, and dyspepsia. These disorders often arise in the 
course of the present attack, but there are cases in which the 
visceral diseases are of long standing, and I have, many times, 
found dropsy added to this present catalogue. It is often dif- 
ficult to decide on the best mode of treating these case'?. My 
plan is, to use the means above recommended to stop the chili 
in the promptest manner. I have never used arsenic, where 
the symptoms of dropsy had occurred ; but all other remedies 
for chill, I have used without regard to the presence of dropsy, 
inflammation of the liver or spleen, or disorders of the stom- 
ach or bowels. I take this course with full conviction, that 
the recurrence of the chills and fever, keep up, if they have 
not caused, all the attending disorders ; and that these will be 
more readily disposed of, after the chills have been checked. 
I will add, that I have pursued this course in many instances, 
where the cases looked very unpromising ; and am well satis- 
fied with its results. 

RECAPITULATION OF REMEDIES. 

1. During the chill, give no active remedy, and administer 

/ 



INTERMITTENT FEVER. 149 

no stimulant. Let the patient be indulged in warmth and 
quiet. 

2. During the hot and sweating stages, remedies are not al- 
ways necessary. If the fever runs high, and has lasted many 
hours in previous parox} T sms, active remedies become neces- 
sary. In such cases, give ten grains of calomel, and a table 
spoonful of antimonial mixture, once in two or three hours. If 
it proves emetic, stop the mixture ; and if the patient seems 
much exhausted, give from thirty to sixty drops of laudanum. 

3. Laudanum, or opium, is proper, not only to check exces- 
sive operation from other remedies ; but to allay irritation, 
and brihg the paroxysm to a close, by exciting a full perspi- 
ration. When the fever has got to its height, and begins to 
decline, give a full dose of laudanum, say sixty drops. If the 
case is of uncommon severity, this remedy is the more neces- 
sarv. Its effect is, in a high degree, comforting and agreea- 
ble". 

4. Cold affusion. When the fever runs high, whether there 
is a dry skin or a free perspiration, make free application of 
cold water. Use it freely, as long as the heat is very great. 

5. Quinine, is the great remedy for intermittent fever. From 
ten to twenty grains is enough to prevent the recurrence of a 
chill. If the chill comes daily, give the remedy within six 
hours before it is expected. Make twenty grains of quinine 
into eight pills; commence six hours before the chill, and 
give one of these pills hourly, till all are taken. If the case is 
not violent, ten or fifteen grains, divided into the same num- 
ber of doses, and given in the same way, will be sufficient. 
If the chili comes on every second, or every third day, a longer 
period is allowed for giving the quinine. In these cases, take 
twenty grains of quinine, and divide it into twelve pills. Give 

four of these pills in the course of the day before the expected 
chill, and the remaining eight, within the last six hours, as di- 
rected above. Where the chill comes only once in three days, 
,or even at a longer period, it is not necessary to give the qui- 
,nine any longer before the expected chill, than when it comes 
every second day. The quinine is to be given in this manner, 



from time to time, till the chill is broken, when it is to be laid, 
aside. To prevent a relapse, it is prudent to give this reme- 
dy again, at the end of a week, from the date of the last chill ; 
and in like manner, at the end of the second week, and even 
on the end of the third week ; for these are the periods at 
which relapses are likely to happen. In these cases, give the 
remedy for a day only. 



150 ERUPTIVE FEVERS. 

6. Arsenic. The arsenical solution, or Fowler's solution, as 
it is commonly called, is the only form of this remedy, which 
I advise to be given in intermittent. Ten drops, two or three 
times a day, are sufficient for a grown person. It may be in- 
creased, from day to day, till the dose is twenty drops, if it 
produces no ill effect on the stomach. This remedy is to be 
suspended, if it produces dropsical swelling of the legs. 

7. A few hours before the chill is expected, a powerful 
stimulant may be given, with the hope of arresting it. A tea 
spoonful of laudanum, in a cup of warm tea, is probably the 
best. A less dose will suffice, in milder cases; and with a 
proper use of quinine, this will seldom be necessary. 

Intermittent fever often comes on in persons who have other 
disorders. Dropsy, liver disease, and enlargement of the 
spleen, are the most common. In these cases, the removal of 
the chills and fevers is the first object. The quinine espe- 
cially, is to be given as freely as if no such complaint was pre- 
sent. 



ERUPTIVE FEVERS— EXANTHEMATA. 

Modern authors have agreed to treat under this signification, 
all diseases which are attended with fever, produce an erup- 
tion of the surface, originate from a specific contagion, and oc- 
cur, to the same individual, but once in his life. The number 
of diseases of which I shall treat, under this class, is small- 
restricted to measles, small-pox, scarlet fever, chicken pox, 
and roseola. The attack of these diseases is always attended 
with fever, and they produce, after a given time, an eruption 
on the skin. This eruption is peculiar in each disease, and it 
is often doubtful till it appears, to what class the case belongs. 
Nor is it always easy to discriminate between them ; scarlet 
fever and measles are not unfrequently mistaken for each oth- 
er. There is also a disease which is still more embarrassing 
to the practitioner. Roseola, or rose rash, is so difficult to dis- 
criminate, that an individual case will sometimes deceive the 
most cautious observer. This has given rise to the many re- 
ports of persons having a second attack of measles or scarlet 
fever. These diseases ought therefore to be noticed closely, 
and care taken that no mistakes be made. 



SMALL-POX. 151 



SMALL-POX. 

This disease was unknown to the ancients. It appears to 
have originated about the middle of the sixth century; and it 
is uncertain, whether it first occurred in Egypt or in India. — 
The subject appears to have been treated of by the general his- 
torian, for several centuries ; so that our accounts of it, are 
wholly inaccurate, for the first three or four centuries of its 
existence. Towards the tenth century, it appeared in Eng- 
land, having been previously the common disease in Europe 
for ages. Its progress since that time, has been better under- 
stood. Within twenty-five years after the discovery of Ame- 
rica, it made its appearance in Mexico. Soon after, it appear- 
ed in other parts of the Western continent, attended with a 
mortality seldom witnessed in any other disease. 

Few diseases have attracted more of the attention of medical 
men, than this. Its importance can scarcely be overrated. Du- 
nns: the first ei°:ht centuries of its existence, its course was lit- 
tie impeded by the efforts of medical men, and as little attend- 
ed to by the governments through whose countries it travers- 
ed. Under the general term of plague, it has been indefi- 
nitely alluded to, as having swept off one fourth, or one sixth, 
or one eighth part of nations ; and it is not extravagant to say, 
that within two hundred years of our times, this dreadful 
scourge was regarded as the destroyer of at least one sixth 
part of all the human race that was born. 

The treatment of this disease, till the days of Sydenham, in 
1667, was, to say the least of it, exceedingly bad — the whole 
object of the practitioner, being apparently to throw out the 
greatest possible eruption, by the use of internal, and external 
stimulants. This great man produced a great, revolution in 
the treatment of this disease, as well as in many others. In- 
deed it is hardly extravagant to say, that from the date of his 
writings, medical men, and medical reasoning have taken a 
different character. 

It is scarcely less strange, that for a thousand years after the 
first appearance of this disease, its contagious character was 
not understood. Indeed, Sydenham appears to have had 
scarcely an idea of it ; and it was left for Boerhaave, about 
forty years afterwards, to inform the world, that smallpox was 
a contagious disease. It will appear almost incredible to most 
. of my readers, to be told that even at the present day, a great 



152 SMALL-POX. 

proportion of the people of Europe, believe that small-pox, 
like other diseases, is without any particular dependence on 
contagion or infection. 

The great improvement in the treatment of small-pox, in- 
troduced by Sydenham, turned principally on avoiding the 
stimulants which had, before his day, produced such dread- 
ful havoc. He introduced a cooling and depleting treatment ; 
and this is perhaps the principal merit, which his mode of 
treatment had over that of others. But this dreadful disease 
was doomed to submit* to more efficient means of arrest. In- 
oculation, introduced I believe from the East, was resorted to 
in Europe, and while it served to protect those who were in- 
oculated, in a wonderful degree, gave rise to a dissemination 
of the contagion amongst those who refused to submit to its 
influence, which was truly fearful. There can be no doubt 
that small-pox was, a century ago, more disseminated over 
the earth, and more destructive to human life, than it ever was 
at any time before. But we have lived to see a second great 
revolution in the management of small-pox. Vaccination, in- 
troduced about the beginning of the present century, has al- 
most robbed of its terrors, this once awful pestilence. 






x> ESCEIPTION. 






Small-pox, when taken in the natural way, may be divided 
into three stages. The first has been termed incubation — 
which commences from the time the infection is received into 
the body, and terminates with the appearance of the eruption 
on the skin. The second has been termed maturation, which 
lasts from the appearance of the eruption till the formation of 
matter or pus in the pustules. The third is the decline; and 
lasts from the state of maturation to the close of the disease. 

From the exposure to the infection, to the appearance of the 
disease, an uncertain term, of from one to three weeks, is 
passed. Till the fever which precedes the eruption takes 
place, the patient has experienced no symptom by which he 
could be certainly known to have an approaching attack. — 
Some indeed have been known to complain of certain symp- 
toms of faintness and sinking ; but, these symptoms are not 
to be looked for. The disease is ushered in by a sensation of 
cold, with an involuntary shivering of the whole body. Nau- 
sea, dizziness, headache, pains in the back, and limbs, with 
more or less fever, follow. In extreme cases, vomiting, ten- 
derness in the region of the stomach, delirium, hemorrhage 



SMALL-POX. 153 

from the nose, and, in small children, convulsions are fre- 
quently met with. Death, in some cases, occurs before any 
eruption has made its appearance ; and, in many instances, 
it has remained doubtful, whether the disease was really a 
small-pox. The eruption makes its appearance, in about for- 
ty-eight hours after the attack. This time may occur in the 
mildest, as well as in the most malignant cases ; but the time 
at which the eruption occurs, is frequently considerably la- 
ter — frequently extending to the third or fourth day. 

The next stage, or the stage of maturation, succeeds to that 
of the eruption, of which we have just treated. Small points 
of eruption, called papulae, appear on the face and wrists, at 
first pointed and easily felt above the skin, but in other re- 
spects very minute and indistinct. After a day or two, they 
acquire considerable hardness ; and, by passing the finger 
over them, feel very like shot buried beneath the skin. This 
sensation is so unlike any other ever felt by placing the hand 
on the human skin, that I can compare it to no other ; and 
having once felt it, it seems to me it should never again be 
mistaken for any other disease. The intensity of the attack, 
is judged of by the number of the pustules. The danger is in 
due proportion to the number of these, especially when found 
over the head and face. There is, therefore, no certain line 
of distinction between the milder, and the more malignant 
cases of small-pox. 

These pustules are seated in the true skin, and become, 
each in its place, a separate centre of inflammation. In three 
or four days, a sort of blister appears on their surface, which, 
in four or five days more, is succeeded by the formation of 
matter or pus. Around each of these small pustules, a circle 
of inflammation is formed ; the skin is thickened, and a de- 
pression is seen over the centre of the pock. More or less fever 
has thus far attended the disease ; but the pustules now burst, 
the matter from them escapes, the fever subsides, and the pa- 
tient is well. In cases still milder, the pustules dry up with- 
out the formation of matter — forming a small horny scab, which 
some of the older writers denominate horn pock. Such is the 
course and termination of an ordinary attack of small-pox. 

Far more formidable is the attack of this disease, when, 
from the great number of the pustules, they run together, form- 
ing what has been termed the confluent small-pox. The 
symptoms which lead to this, are not always distinguishable 
from those we have described above. They are far more vio- 
lent, and this perhaps may be a sufficient account of the dif- 



154 SMALL-POX. 

ference. It may however be well to suggest, that where the 
patient is seized with great stupor, delirium, feeble pulse, cold 
extremities, and scattered bluish spots on the skin, which have 
been termed petechia, a confluent eruption may be reasonably 
feared. A great change in the whole character of the disorder 
is to be expected in these cases. Previous to the appearance 
of the. eruption, the skin on the head and face becomes tumi- 
fied and inflamed. The eruption, in numerous points, may be 
discovered, and, in four or five days, the eyes are closed by 
swelling — the skin over the head and face extremely tender — 
the glands of the neck and throat much swollen — a salivation 
commences, and frequent abscesses under the arms, and in 
the groins occur. No distinct circle of inflammation is seen 
around the individual pock ; but, running together, they seem 
to constitute the whole surface of the body, especially the 
face, one sore. If perchance the individual is left with sense 
and reason, no sleep comes to his relief; but interminable rest- 
lessness, great exhaustion, rapid pulse, and all the symptoms 
which characterise a constitution overpowered, are present. 
The eruption, in these cases, often extends beyond its ordina- 
ry ground, penetrating the mouth, the nostrils, and often ex- 
tending down the windpipe to the lungs. A rigid hardness of 
the mouth, tongue and throat, renders it difficult to swallow; 
and the swelling in the nostrils and about the throat, is fre- 
quently a cause of strangulation, even to the destruction of 
life. Nothing can be more awful than the contemplation of a 
human being, under this accumulation of suffering. 

Considering that in the small-pox, when taken in the natural 
way, no preparation or selection of time is allowed, it may be 
expected that many individuals will be attacked by it, when 
laboring under other disorders, or otherwise in a state of ill 
health, not readily admitting of their safely entering into a con- 
flict with a new disease. Scrofula has been most frequently 
alluded to by writers, as the great cause of increasing the dan- 
ger of small-pox. Equally dangerous has been thought that 
plethora and over fulness, which is the result of excess in eat- 
ing and drinking. Complicated with these disorders, small- 
pox frequently produces disorders that appear no way con- 
nected with its usual course. Deep seated abscesses — espe- 
cially in the lungs, wide spread inflammation resembling scar- 
let fever or measles, and, in some cases, apparently identical 
with erysipelas, follow in the train of this disease. So fre- 
quent were these complications, and so difficult of discrimina- 
tion did they appear, that, for ages, this disease was imper- 






SMALL-POX. 155 

fectly, if at all, discriminated from measles and scarlet fever. 

The third stage of small-pox, has been termed its decline. — 
It appears that nature has not endowed it with a power of sup- 
porting inflammation, beyond a certain term. After the for- 
mation of matter in the pustules, it appears that the patient 
has but to recover from the damage that has been already done 
him. The active force of the disease seems to be at an end. — 
In milder cases, about eight days after the appearance of the 
eruption, the pustules burst, and the cure progresses without 
any interruption. In worse cases, the healing of the ulcera- 
tion is slow ; and, in the cases which have become confluent, 
and, in some in which they were apparently mild, a seconda- 
ry fever, as it has been called, occurs. With the disappear- 
ance of the eruption, a fever more violent than any the patient 
has yet experienced, takes place, and is protracted to an in- 
definite extent. This fever is commonly attended with the lo- 
cal disorders which have been alluded to — the abscess, inflam- 
mation, &e. But, in some cases, it seems to depend on causes 
little understood. No local disorder is manifest, and yet the 
fever is more violent, and more dangerous, than that which 
has preceded it. 

The degree of danger which may attend a case of small- 
pox, is a matter of deep interest ; and much has been said on 
the symptoms which indicate a favorable or unfavorable ten- 
denc} r . It is manifest that each individual pock, is so much to 
bear ; and, that in proportion to their number, the danger is in- 
creased. When their number is so great, that they have not 
room to form individually ; but run together, the disease is 
manifestly dangerous. When this happens over a ver} r great 
portion of the surface ot the body, the danger is still greater: 
but the symptoms of danger frequently arise before the ap- 
pearance of the eruption. That prostration which produces 
stupor, great loss of strength, cold extremities and blueness of 
the surface, cannot be otherwise than exceedingly dangerous. 
Experience has taught us, that a great deal depends on the 
habit of the patient, as well as on the age. Infants are exposed 
to much greater danger than children of seven years old and 
upwards ; and persons more than forty years of age, seldom 
recover from formidable attacks of small-pox. 

CONTAGIOUS CHARACTER. 

It is of great consequence that a disease so formidable, should 
be as limited in its number of victims as possible. It was, 



156 SMALL-POX. 

therefore, a great point gained, when it was decided, that small- 
pox invariably arose from infection. That the greatest benefit 
may be derived from the knowledge of this fact, it is very im- 
portant that the means of avoiding this contagion, should be 
understood. That the sick who accidentally take this disease, 
should be attended to, and all their wants supplied, is a first 
principle of morality. Nothing can excuse the want of it. — 
The first thing to ascertain is, by what means the infection 
can be spread ; and to what distance it may be propagated ? 
These questions have been investigated with great diligence 
and care. It is agreed that from the bodies of patients having 
small-pox, whether the disease has broken out or not, or, in- 
deed, at any time during the existence of the disorder, there 
proceeds an effluvium or infecting agent, by being expos- 
ed to which, those who have never had the disease, will 
contract it. To what distance this infection may be propaga- 
ted, is not determined. Some have limited it to a few feet ; I 
believe the majority limit it to about thirty feet. My own 
opinion is, that where a great accumulation of cases exist, as 
in a hospital, it might be propagated to a greater distance. — 
The smallest portion of matter taken from an infected person, 
seems capable of producing the disease, by being brought near 
to the person of another, without even coming in actual con- 
tact. So subtle and searching is this infection, that we hardly 
know when our care has been sufficient to avoid its propaga- 
tion. It is, therefore, of the greatest importance, that the cus- 
tody and management of the infected, should be in the hands 
of the most discreet persons. Contact of the matter from in- 
fected persons, has been known of itself to produce the dis- 
ease ; but its introduction into a wound, as in inoculation, has 
been converted into a great means of lessening the violence of 
the disease. Of this we shall speak more hereafter. Pecu- 
liar states of the atmosphere, have been thought to favor the 
spread of small-pox. Cycles of time have been fixed for this 
state of atmosphere, and it has been thought that six or seven 
years were the periods, at which the disorder acquired this 
peculiar power of self-propagation. Sydenham, the founder 
of this notion, I think assigned the term ot six years. My own 
opinion is, that there is no justice in this assumption of a time 
when the small-pox has acquired this peculiarity of self-propa- 
gation. If the disease has not been in. a neighborhood or city 
within six years, a great many children will have acquired 
years sufficient to make them a community peculiarly quali- 
fied for its propagation ; and this is the only reason for small- 



SMALL-POX. 157 

pox appearing more extensively at one time than another. 
We have seen that small-pox is so infectious, that it is com- 
municated from the sick to the well, at any time in its whole 
course. The mildest possible form of the disease, is as capa- 
ble of producing it in its most violent form, as any other. Even 
the varioloid, which occurs in those who have been vaccina- 
ted, is as capable of being: propagated in the form of a violent 
small-pox, as any other. The first fatal case of small- pox 
which I ever witnessed, occurred in a person who had never 
been nearer than two hundred miles to the small-pox. His 
friend who had been vaccinated, in coming South from New 
York, came on board a ship some passengers of which had small- 
pox. He arrived in Milledgeville with a slight fever, on ac- 
count of which I was consulted. No eruption was apparent, 
nor any other reason, but his late trip, for supposing his dis- 
ease had anv relation to small-pox. In this state he slept on 
the same bed with the person I have alluded to, who, in twelve 
davs, was attacked with small-pox which proved fatal. 

TREATMENT OF NATURAL SMALL-POX. 

Few diseases are more difficult to treat properly than small- 
pox, where it occurs in the natural way. The uncertain- 
ty of the nature of the disease, previous to the appearance of 
the eruption ; the peculiar treatment, when considered merely 
as an inflammatory disease ; and the radical difference which 
must be made in the treatment of cases of great malignity, 
present questions of no common difficulty. 

In ordinary attacks of small-pox, when the disease is of or- 
dinary violence, and no symptoms of prostration are present, 
the usual remedies for inflammatory diseases, are proper. — 
Cathartics of calomel, with a small proportion of tartar emetic 
combined, have had more reputation perhaps, than any other 
remedy. To a grown person, ten grains of calomel, with half a 
grain or a grain of tartar emetic, made into two or three pills, msy 
be given at once. To persons particularly susceptible to the ac- 
tive operations of medicines, the tartar emetic might prove too 
active, and should be lessened in quantity or left out. The 
nausea which commonly attends the first days of the attack, 
is no reason for leaving out the emetic : on the contrary, I 
should conceive it the more necessary, to add the tartar emet- 
ic, in such cases. Nor should I forbear the addition of tartar 
emetic, even in children of the tenderest age, taking care to 
reduce the quantity in due proportion. This remedy may be 



158 SMALL-POX. 

repeated, once in two or three days, till the eruption is fully 
formed, and the pustules begin to fill. Other remedies quali- 
fied to reduce inflammation, may also be used. The antimo- 
nial solution composed of two drachms of nitre and two grains 
of tartar emetic, dissolved in half a pint of water, is perhaps 
the best. It may be given, in doses of two tea spoonsfull to a 
grown person, from time to time, when the heat of the body 
and fulness of the pulse, are too great. Other remedies have 
also been recommended during this stage of the disease — senna 
and salts, castor oil, seidlitz powders, or other mild cathartics. 
These may be given in cases in which the active remedies 
above referred to, may not appear to be necessary. For it is 
always to be borne in mind, that, in small-pox, the safest cases 
are those in which a manifest heat is felt over the whole body, 
especially on the extremities ; and if these symptoms are mode- 
rate, very slight remedies alone are called for. Before leav- 
ing this subject, I will mention another remedy — bloodletting. 
If the nature of the case is sufficiently certain, on its first ap- 
pearance or within the first three days, I should not hesitate to 
recommend the extraction of blood, if the symptoms of inflam- 
mation were high. The remedy, however, in common prac- 
tice, is verv much limited in its use from the fact, that, in the 
beginning, we are seldom certain of the nature of the disease. 

The object of the physician in treating this disease, is to les- 
sen the eruption ; for the danger is almost in due proportion to 
the number of the pustules. In the disease, when arising from 
inoculation, the exposure of the body to cold air, has produ- 
ced effects most wonderful. It is denied that these remedies 
are equally efficacious in the disease, when taken in the natu- 
ral way. My own opinion is, that the surface of the body 
should be studiously kept cool ; that the patient should be de- 
nied the comfort of a soft bed, and placed on a mattrass with 
covering as light as the temperature of the external air will ad- 
mit. The face especially should be kept cool or cold. Fre- 
quent bathing in cold water, and especially the avoidance of 
the warmth of fire, are particularly necessary. Light also has 
been thought to increase the eruptive process. That the eyes 
should be carefully guarded from too much light, is manifest- 
ly necessary : but I doubt whether the ordinary light of rooms 
produces a sensible effect on other parts of the body. 

As soon as the pustules about the face are full, and perhaps 
a few of them burst, all further means of depletion are to be 
discontinued. The parts readily form scabs, and no external 
application is considered necessary. In some cases, however, 



SMALL-POX. 



159 



the flow of matter is so considerable, that applications of starch, 
hair powder, or Lapis Calaminaris, made with great freedom, 
have been found useful. 

The stage of decline requires very few remedies. A gradu- 
al return to nutritious diet and restoration of the comforts of a 
soft bed and warm cover; and, in cases of great exhaustion, 
a moderate use of wine or brandy and water, constitute the 
whole remedial agents which are necessary. 

The treatment of confluent small-pox, requires considerable 
variation from the above. The degree of prostration present, 
with the coldness of the extremities, a soft pulse, and other 
kindred symptoms, demand the supporting hand of remedies. 
They indeed seem to call for decided and powerful stimulants, 
as well as local applications of heat and irritating remedies. 
Great judgment is necessary in the administration of these 
means. They should be used to the point that is absolutely 
necessary, for the support of the patient, and no further. — 
There can be no doubt that death would, in many instances, 
occur, but for the administration of a timely stimulant. The 
most important of these, is, I have no doubt, opium in its va- 
rious preparations. Even lethargy or stupor forms no objec- 
tion to its administration. I am of the opinion, that they should 
be administered in decided doses, at the longest intervals, that 
the symptoms would seem to warrant. Sixty drops of lauda- 
num, once in twelve hours during the first two or three days, 
is, in my opinion, a better mode of administering this remedy, 
than smaller dcises at shorter intervals. External warmth is 
perhaps a more difficult remedy to administer beneficially. I 
am very clear in the opinion, that the surface should, in gene- 
ral, be allowed to be cool; and that, as long as there is a tolera- 
ble degree of warmth, no external means of lessening the tem- 
perature, are allowable. Indeed the increase of the eruption, 
is so manifest from the exposure of the patient to heat, that the 
risk, if any, should always be on the side of too little, rather 
than too much exposure to this agent. 

The difficulty in treating cases of this kind, is very much 
increased from the uncertainty, previous to the eruption, of 
the character it will put on, whether the case will be conflu- 
ent or distinct. The great object will be, to procure a distinct 
eruption ; and this will evidently be best promoted, by the 
cool regimen. I should therefore disregard slight symptoms of 
prostration or sinking, and adhere to the depleting system, and 
cold regimen as long as possible. 

When the maturation is perfect, and a free discharge from a 



160 SMALL-POX. 

large portion of the surface of the body, is seen, the object we 
are to have in view in the treatment is more obvious. Nothing 
need be feared from the use of generous food, wine, fermented 
drinks, or other stimulants. They should be used with unifor- 
mity, and to a reasonably supporting extent. 

Such is our treatment of ordinary small-pox when taken in 
the natural way — whether it be distinct, or confluent ; but we 
are not always rid of this disease, by getting through with its 
ordinary symptoms. Many local inflammations occur, and 
become perhaps more dangerous than the disease itself. Sec- 
ondary fever also arises at the close, sometimes, in cases that 
appeared to be of the mild type. In cases more violent, this 
consequence is still more likely to follow. Great uncertainty 
rests on the cause of this attack ; and physicians have never 
been able to predict, before hand, whether the patient would 
have secondary lever or not. This form of the disease occurs 
at the drying up of the pustules, and, many times, puts on a 
a more violent inflammatory action, than had existed at the 
outset of the disease. Nor is this second attack less dange- 
rous than the first. Many who have borne the severest afflic- 
tions of the first stages of the small-pox, sink at last under this. 

The symptoms of secondary fever in small-pox, vary but lit- 
tle from ordinary inflammatory fever. Commonly there is 
manifest some local disorder, inflammation ot certain parts of the 
surface, swellings and suppurations of the glands, of the arm- 
pits or groins, deeper seated abscesses, frequently of the lungs, 
but very seldom of any part of the abdominal, viscera. The 
duration of the fever will depend very much on: these collate- 
ral symptoms; and the termination of the disease, when it as- 
sumes this form, may be very distant. 

The treatment of secondary fever differs very little from that 
of ordinary attacks of inflammation. The patient is found to 
require as active treatment, and, oftentimes more active, than 
that which was found necessary in the first stage of the dis- 
ease. Purgatives of calomel and rhubard, castor oil, or other 
similar remedies, are freely used. They are to be continued, 
from time to time, according to the duration of the disease, and 
the presence of inflammatory symptoms. Opium is not to be 
forgotten in this stage of the disease. Great relief will, many 
times, be obtained by the use of laudanum, once in twenty-four 
hours or oftener, when the pain and restlessness are extreme. 
The disappearance of the local disorder, whether it be an ery- 
sipelas or an abscess, will terminate the secondary fever. If 
the abscess forms, and is discharged, the same course of treat- 



SMALL-POX. 161 

merit should follow, as that directed when the pustules have 
suppurated. The patient should be judiciously sustained by 
the use of opium, camphor, brandy, quinine, &c. 

Particular symptoms occur in the course of this disease, 
which may call for remedies not herein mentioned. If a vio- 
lent local inflammation about the throat, is present, leeches 
may be applied. A special application of cold will be proper. 
If the scalp is particular^ the seat of the disease, the hair 
should be closely cut ; and any abscess which may form under 
the skin, should be freely opened. The pits or scars which 
are left in this disease, and so disfigure the sufferer, have been 
a subject of much discussion and of many suggestions. Little 
reliance is placed in any of the remedies which have been men- 
tioned, for the prevention of this mischief. The most reasona- 
ble proposition which I have met with, is, the application of 
lunar caustic to the pustule before the stage of maturation, say 
on the fifth or sixth day of the disease. At this stage a drop of 
transparent fluid will be found on the surface of each point. 
A pointed piece of lunar caustic is pressed down on it, and 
suffered to remain for a few seconds. Each pustule is treated 
in this way. I have no experience in the use of this remedy, 
but should not fail to try it, if I should again have a case that 
might be benefitted by it. 

SECOND ATTACKS OF SMALL-POX. 

We have placed this disease amongst those of which an 
attack of the same person, is to be apprehended but once 
in life. No disease is better entitled to this distinction than 
small-pox ; yet there do occur cases of a second attack. 
These attacks are almost always of the mildest grade. They 
are so rare, that many experienced physicians have never 
witnessed them. It is said, that there is no reported case of 
a single individual having returned to the hospital, in which he 
was treated in the first. In the small experience I have had, 
I have witnessed the small-pox in a person who had been 
regularly inoculated for that disease, thirty years before, but, 
on exposure to the presence of a person who had the disease, 
took the infection, and had the disease in its usually mild form. 
The second attack of small-pox, requires no treatment differ- 
ent from that of the first. It should be treated according to 
its degree of force. The pustules are said, in these cases, to 
be more superficial than those in the original attack. Such 
appeared to be the case in the individual, in whom I saw this 
11 



162 SMALL-POX. 

form of the disease. Only a very small number of the pocks 
formed matter ; the rest termed dry scabs, and thus passed 
away. The only reason I have for mentioning second attacks 
of small-pox, is, to enforce the idea of perfect impunity, with 
which those who have had the disease, may attend to the sick. 
They are almost absolutely free from the danger of a re-infec- 
tion ; and, as far as I know, no case of death occurring from 
this cause is recorded. 

INOCULATED SMALL-POX. 

This disease had been known to the profession, at least a 
thousand years, before the discovery of inoculation. By whom 
this great discovery was made, is not. known ; but it was found 
in common use in the city of Constantinople, the first part of 
the eighteenth century. From this city it was brought to Eng- 
land by Lady Montague, who has the rare merit of having 
given to the physicians of her country, a great improvement in 
the medical art. For the first twenty years after its introduc- 
tion, it was violently opposed by medical men ; but, in the 
course of half a century, it was universally recognised as the 
safest means of lessening the ravages of small-pox. The more 
enlightened part of every country in Europe, availed them- 
selves of this happy discovery ; but it is to be lamented, that 
the mass of the lower orders, were still exposed to the ravages 
of small-pox ; and there is reason to believe that the mortality 
which arose from it, was not lessened, up to the date of Jen- 
ner's discovery of vaccination. 

The difference between small-pox, when induced by inocu- 
lation, and contracted in the ordinary way, is very remarkable. 
The danger of the inoculated small-pox is so small, that, un- 
der a judicious system of management, the mortality has been 
reduced as low as one in a thousand ; while the disease, when 
arising in the natural way, destroys, on an average, three in 
ten, and, in some particular seasons, the mortality has been 
much greater. The most important difference exhibited by 
the disease, contracted in these different ways, consists in the 
fact, that after inoculation, the disease is brought on in a shor- 
ter time, than after the exposure to infection in the natural way. 
Physicians have, from this cause, availed themselves of the art 
of inoculation, to give to those who had been exposed to the 
infection, a mild, instead of a very fatal disease. In this way, 
previous to the invention of vaccination, a general inoculation 
in a neighborhood, in which the small-pox had made its ap- 



SMALL-POX. 



163 



pearance, has been used to arrest the disease in its progress. 
The discovery of inoculation would have been nearly sufficient 
to have robbed the disease of all its terrors, had communities 
consented to its universal adoption. 

The mode of introducing into the system, the contagion 
of small-pox by inoculation, is very simple. The matter 
should be taken from the pustule before the formation of pus; 
but it is agreed, that there is no danger from using the matter 
at anv stage, nor is there any increase of danger by using mat- 
ter taken from, even the most malignant cases. Nor is it known 
that the propagation of this disease, in this way, has ever giv- 
en rise to the propagation of other diseases. A very slight in- 
cision is made in the skin with the point of a lancet: the lancet 
is then dipped into the matter to be inserted, and introduced 
into this same orifice — the whole cut being so small, as scarcely 
to cause the flow of a drop of blood. Indeed the operation is 
most successful, when the lancet is passed under the epidermis 
without drawing blood. The point most suited to this opera- 
tion, is the external surface of the arm, three fourths of the 
distance from the elbow towards the shoulder. A single point 
only should be touched; for I have no doubt the inflammation 
and fever would be greatly aggravated, by giving it an oppor- 
tunity of commencing at more points than one. Indeed the 
fearful scars which I have seen on the arms of old persons, 
who had submitted to inoculation by the antiquated plan of 
inserting a thread for an inch or more in the skin ; as well as 
the fearful account such persons have given me of the inflam- 
mation they experienced in the arm, would of itself convince 
me that it was best to avoid such a mode of inoculation. 
Great care should be taken that the person who is to submit to 
the inoculation, should guard against taking the disease in 
the natural way at the same time. The distance between 
the individual from whom the matter is taken, and that into 
whom it is to be inserted, should never be less than ten paces : 
advantage should also be taken of the course of the wind. In 
most cases, it will be best to take the matter on a piece of glass 
from the diseased subject, and carry it to a sufficient distance: 
should it grow too dry, a little water may be added to moisten 
it. Such are the simple means necessary to propagate small- 
pox by inoculation. 

TREATMENT. 

The treatment of small-pox fiom inoculation, begins im- 
mediately after the inoculation is performed. The paiient is 



164 SMALL-POX. 

to be separated from all healthy persons, who are liable to 
srrmll-pox ; placed on alow regimen, scarcely any animal food 
to be allowed, and, with equal care, to be guarded against 
exposure to the extremes of heat and cold. After three days 
a cathartic of calomel should be given, and, during the next 
two or three days, a daily dose of Seidiitz powders or Epsom 
salts may be given. If the patient is robust, these remedies 
may be repeated oftener : but the above is sufficient in ordina- 
ry cases. The arm in which the matter has been inserted, 
will probably be painful, and a good deal swollen : to this, 
frequent applications of cold water should be made. If the 
case is considered violent, sugar of lead may be disolved in 
the water to be used. Little more need be said in regard to 
the treatment of small-pox from inoculation. Reference, in 
cases that appear to be worse than common, may be made to 
what we have said above in treating of the small-pox, when 
taken in the natural way. 

MODE OF ARRESTING THE PROGRESS OF SMALL-POX. 

Vaccination is so far from being universally adopted, that it 
is, at all times, a matter of fear when it is announced that the 
small-pox has made its appearance in any neighborhood. In 
this country, the contagious character of the disorder is uni- 
versally believed ; and the violent measures which have been 
resorted to, to arrest its progress, have been, in many in- 
stances, disgraceful. It is not many years since a poor wag- 
oner on the high way, in Georgia, was known to have small- 
pox. Some courageous person threw down a fence through 
which he drove to a barn into which he entered, where he lay 
neglected and died — without, so far as 1 have heard, the pres- 
ence of a human soul. His burial was as savage as his treat- 
ment : a torch was applied to the barn and it was burned 
down. But little less savage has been the practice in other 
places. The sufferer with small-pox has been, with us, too 
frequently a doomed man. Those whose humanity has in- 
duced them to visit him, have been forbidden to return to their 
own houses. Even the physician has been made an outlaw 
and avoided, as if his intercourse with the sick constituted him 
an embodiment of pestilence. That a great part of this fear 
is groundless, ought to be known to the world ; and that the 
common calls of humanity should never be denied to the vic- 
tim of this disease, ought to be a fixed principle. 

When the small-pox makes it appearance, the individual in 



SMALL-POX. 



165 



whom it has appeared, if he is a traveller, should by no means 
be allowed to proceed. His wants should be provided for at 
the nearest convenient point. He should be placed in some 
location where he can be separated from others, to a distance 
of thirty feet or more ; and no cruel attempts to send such in- 
dividuals into remote and lonely places, should be made. It 
will seldom be necessary to remove the individual beyond the 
precincts of any town or village, in which the disease may ap- 
pear. He should be placed in the custody of individuals who 
have had the small-pox, if such can be found : if not, those 
who have been vaccinated may perform this important duty, 
with perfect safety to themselves, and but little danger to the 
community. Great care should be taken in bringing any thing 
from the habitation of the sick. The matter of the infection 
may produce the disease, either by being applied to the sur- 
face o{ an individual, or placed too near for breathing its odor 
with safety. The articles that must needs be brought away, 
require no further cleansing than the ordinary use of soap and 
water ; and nothing is infected except by the actual application 
of the matter of small-pox. The hanging of clothing in the 
same room with the sick, does not convert that clothing into a 
means of transmitting the disease. The care necessary to avoid 
the transmission of the disease, will hardly be observed by 
nurses or attendants. These should remain at hand or near 
the patient. Nor is it necessary to destroy the clothing of pa- 
tients or attendants. All are rendered dean by the ordinary 
operation of soap and water. 

The physician whose duly calls him to attend to patients un- 
der these circumstances, should be exceedingly careful in his 
mode of proceeding. Many have, in the performance of this 
duty, infected their children ; and all should be informed of the 
safest means of entering into, and safely leaving the abodes of 
the sick with small-pox. The suggestion most commonly re- 
lied on, is an exchange of clothing on entering, and putting them 
off on leaving. Such clothing is generally made loose and 
flowing, and more apt, than ordinary raiment, to come in con- 
tact with the matter of small-pox. I am decidedly of the 
opinion, that such arrangements increase, rather than diminish, 
the danger. The physician should carefully avoid coming in 
contact with any thing in the room. He can perform his duty 
without any contact except the hand ; and this he should al- 
ways take the greatest care to cleanse, before leaving the 
room. At the door, a change of shoes for a pair that should 
never leave the place, will be prudent : and these are all the 



166 SMALL-POX. 

precautions I have found it necessary to use. I have, in this 
way, made many visits to the sick with small-pox, and have 
never had reason to believe, that I brought from these visits, 
any portion of the infection. We need not add much on the 
subject of avoiding the propagation of small-pox. Those who 
have been exposed to its contagion, in a way too manifest to 
admit of escape, should be instantly vaccinated, if that be pos- 
sible. I will not suggest a resort to inoculation, because vac- 
cination is, or ought to be, possible under almost any circum- 
stances which may arise; but should the time occur in which 
vaccination shall not be possible, a resort to inoculation would 
unquestionably be proper. 

VACCINATION. 

Every reader will have heard of vaccination. To some it 
may be necessary to say, that it is the propagation of a disease 
which originates in the cow, by inoculating with the matter 
thereof, the human subject. This disease in the cow, is an 
eruption which appears on the udder. In the first accounts 
we have of it, it was contracted by milkers — producing in their 
hands a violent inflammation and fever. These persons were 
found not to be subject to attacks of small-pox; and a suppo- 
sition or rumor, that this protection against the attacks of small- 
pox arose from this cause, existed in certain parts of England 
for an unknown time. The mention of this fact in the pres- 
ence of Doctor Jenner, excited his attention. He instantly 
applied his mind to the subject ; treasured up every fact which 
he knew, and discovered others by patient and slow experi- 
ment. Of a philosophical turn of mind, he was exceedingly 
slow to believe his own great discovery. He became, after 
many years,, thoroughly convinced that the opinions of the 
milkers carried with them an important fact. He believed 
that the infection from the disease of the cow, when propa- 
gated in the human subject, hindered the occurrence of small- 
pox. He soon found subjects on which to make the experi- 
ment. Every thing succeeded in his hands; and in 1798 he 
announced to the world his great discovery. For a few months 
during the progress of his publication, he was unable, in the 
city of London, to find a subject on which to make an experi- 
ment. This difficulty was at last overcome; and a knowledge 
of the discovery was rapidly propagated. Thousands sub- 
mitted to the operation in England ; and, in a single year, it 
was spread to America and other parts of the world. It was 



SMALL-POX. 167 

at first believed to be an infallible preventive of small-pox in 
any form. Soon however individuals who had been inoculat- 
ed, were found affected by a milder grade of small-pox, pro- 
ducing a degree of distrust in vaccination, from which it has 
not yet thoroughly recovered. That it is not so great and per- 
fect a remedy as its discoverer fondly hoped, is true; but that 
it is still worthy of every commendation, cannot be denied. It 
is still the world's great reliance in destroying small-pox. We 
are not allowed to hope that it will, in any reasonable time, 
extirpate this loathesome disease from the face of the earth; 
but every one will acknowledge that through its use, small-pox 
is no longer the scourge of nations. It is pleasing to add, that 
Doctor Jenner did not die without his reward. The English 
government voted him the sum of thirty thousand pounds, 
which, it must be acknowledged, does credit to the liberality 
of that government, although so infinitely short of the value of 

the discoverv. 

«/ 

Nothing can be more simple than vaccination. It is per- 
formed just as inoculation for the small-pox is performed — by 
inserting a small portion of the matter of the vaccine disease 
in the skin of the human subject, by a very delicate operation 
with the point of a lancet. In a few days, a point of inflam- 
mation will be found at the spot; a small circle will surround 
the place ; and apparently a thickening of the skin will hap- 
pen. By the eighth day, a blister is found on the spot, which 
contains a transparent, serum. On opening this blister, a very 
small portion only will flow out : and this portion is that which 
is best used in propagating the disease to others. The disease 
which attends it is so slight, that it seldom requires any reme- 
dy: yet, in a few instances, a considerable fever arises, which 
it is well to treat with a cooling regimen and light cathartic 
medicines. If the arm is much inflamed, cooling applications 
by means of cold water, may be made to it ; and this is all the 
treatment this disease requires. 

A great deal has been said on the danger of using improper 
matter, and relying on an imperfect vaccination, for the hin- 
drance of small-pox. It is true, that in all cases, the judgment 
of an experienced physician is desirable, in deciding when the 
vaccination has been successful ; but, as this is not always 
practicable, it is decidedly best to resort to vaccination when- 
ever an opportunity for it occurs. It will seldom happen that 
an inflammation, brought on after the seventh day, from the in- 
sertion of any kind of matter except that of vaccination, will 
have the slightest resemblance to that disease. The pit or 



168 SMALL-POX. 

scar which follows vaccination, is also worthy of special note, 
and may be judged of by any one. 

SMALL-POX AFTER VACCINATION. 

Vaccination, as I have said, is a perfect protection of the 
life of the subject against small-pox ; yet a milder form of this 
disease sometimes occurs, in persons who have been vaccinat- 
ed; and, — what is most to be deplored — that mild form of 
small-pox, is as infections to those who have never had that 
disease or been vaccinated, as the most malignant small-pox. 
Nor is there any reason to believe that the small-pox, when 
propagated in this way, is any milder than when propagated 
from its more malignant form. I have myself witnessed an 
instance, in which small-pox was contracted from exposure to 
a case of varioloid, as it is termed, so exceedingly mild that 
not a mark of any description was made by it on the skin of 
the patient ; yet the case so contracted proved fatal. 

Small-pox after vaccination, is a mild disease ; not one in 
several hundreds have been known to die. Its treatment is in 
no respect peculiar. The cool regimen and mild means ad- 
vised to combat inflammation, may be judged of by any one. 
Medicines will seldom be necessary ; and. should they appear 
so, be those used in inoculated small-pox will be proper here. 

RECAPITULATION OF REMEDIES. 

Small-pox is most formidable, when its attack has been 
brought on by exposure to the contagion of the disease. It is, 
at best, a highly inflammatory disease, and requires very ac- 
tive treatment. It has been divided into two varieties — the dis- 
crete, and confluent. These cannot be known apart, till the 
eruption has made its appearance; nor is it always obvious, 
at first, to which of these classes the case will belong. If the 
pustules are thinly scattered over the body, it is a case of dis- 
crete small-pox ; if they are so thickly strewn, especially over 
the head and face, that in their growth and development, they 
will necessarily run together, it is a confluent small-pox. The 
danger of the disease, is in proportion to the number of the pus- 
tules. 

The discrete small-pox is a highly inflammatory disease 
which will run its course, so far as to throw out an eruption on 
the skin, and cause a suppuration of some of the pustules. The 
smaller the number of these pustules the better for the patient. 
The remedies are — 



SMALL-POX. 169 

1. Cold applications to the skin. This is probably the most 
important remedy in the treatment of small-pox. During the 
fever, and previous to the appearance of the eruption, the pa- 
tient is to be thinly covered or clothed ; lie on a hard bed or 
mattrass, and carefully avoid exposing the hands and face to 
the heat of the fire. It is said to be equally important to avoid 
exposure to too much light. This course is to be pursued till 
the pustules have filled, and the fever is manifestly on the de- 
cline. 

At the onset of the fever, when there is a full pulse and flo- 
rid complexion, the patient should take the following prescrip- 
tion : Calomel ten grains, tartar emetic one grain, mixed to- 
gether and made into pills, all of which are to be taken at one 
dose. If the patient is robust, and this dose not found suffi- 
ciently active, the quantity of the tartar emetic maybe increas- 
ed to two grains ; or if it is too active, reduced or omitted al- 
together. This is a very active cathartic, and may be substi- 
tuted by others of a milder character. Seidlitz powders, Ep- 
som salts, cream of tartar, or any other mild cathartic, will an- 
swer. A high state of fever may continue for several days, 
and it is not to be expected, that the use of a single cathartic 
will be sufficient for its removal. It is necessary to press the 
remedy so as to reduce the patient, and lessen the eruption. To 
this end, it has been the practice, to give an active cathartic, 
daily, for several days. This I consider very active treat- 
ment, and only allowable in cases of the highest inflammatory 
grade. A very manageable and powerful remedy is found in 
the antimonial solution, which may be given in such doses as 
the stomach will bear without vomiting, whenever the symp- 
toms of fever are considerable. These remedies are to be les- 
sened or suspended, as soon as the eruption has made its ap- 
pearance. From this time the patient is to be allowed a little 
nourishment ; and if his extremities are cold, and the eruption 
very thin, and scattering, a small portion of brandy, or a 
moderate dose of laudanum, should be given. The pustules 
will not require any particular treatment. They require no 
plasters, and are to be allowed to burst and form scabs for 
themselves. If the discharge is very considerable, care should 
be taken to wipe the matter away frequently, and to apply 
starch, or lapis calaminaris, to the parts most affected. Few 
diseases are more benefitted by proper treatment, than small- 
pox ; and there can be but little doubt of the correctness of this 
mode of treatment, in ordinary cases. 

Confluent small-pox differs from the above, only in being 



170 SMALL-POX. 

more violent and dangerous. The symptoms are, from the 
first, more violent, producing in children, coma and convul- 
sions ; and, in grown persons, nausea and vomiting, or deliri- 
um, and sometimes lethargy or coma. The heat of the body 
may, in these cases, be considerable ; but the extreineties will 
be cold, and ihe eruption late in making its appearance. Pow- 
erful stimulants are considered the best remedies to bring out 
the eruption. The best of these is laudanum, and it should be 
given in full doses, every six or twelve hours, till the warmth 
of the patient extends to the extremities. If the case appears 
desperate, brandy may be added, and the warmth of the pa- 
tient kept up by the local application of heat, in any convenient 
way. If, by these means, the pustules fill with matter, there 
is yet hope that the patient will recover, although the discharge 
will be very great, and the danger from this cause considera- 
ble. But, if the pustules fail to fill, and especially if they fill 
with bloody serum, and resemble blue berries in the skin, there 
is very little hope. It is obvious that such cases will require 
every means of support which it is in our power to bring to the 
aid of the patient. He should have wine, brandy, generous 
food, and the most comfortable and warm bed and clothing, 
which can be given him. 

Secondary Jever. After the patient has struggled through the 
first attack of small-pox, and appears to be out of danger, he 
is frequently attacked with a secondary fever, as dangerous, 
and more obstinate than the first. This fever is to be treated 
according to its symptoms; they are commonly inflammatory, 
and are much benefitted by bloodletting. Cathartics of calo- 
mel and rhubard, or other similar remedies, may be used. 
This secondary fever is commonly attended with some local 
disease, it may be an abscess, or an erysipelas. These in- 
flammations will tend to protract the case, and exhaust the pa- 
tient to the last degree. In this state of exhaustion, we must 
again resort to the supporting remedies above mentioned. 

Great efforts have been made, to hinder the frightful scars, 
which disfigure the faces of persons attacked by small-pox. 
I am not sure that much good has resulted from these efforts. 
Lately it has been suggested, that every pustule of small-pox 
which appears on the face, should, as soon as it appears, be 
touched with a pointed piece of lunar caustic, wet and repeated- 
ly pressed down into its centre. This is said to have the ef- 
fect of lessening the scars, in a wonderful degree, and I think 
it worthy of a fair trial. 

Inoculated small-pox. It is only where the vaccine matter 



SMALL-POX. 171 

cannot be procured, and persons are involuntarily exposed to 
the contagion of small-pox, that inoculation is allowable. That 
the disease is robbed of half of its power, by being brought on 
in this way, cannot be doubted. It is therefore necessary that 
the safest plan of doing this, should be understood. 

A very small portion of matter, taken from a pustule of 
small-pox on a piece of glass, and allowed to dry, may be car- 
ried to any distance. It should be carried by a physician, 
who has had small-pox, or attended it after being vaccinated. 
A very small portion of this matter is to be taken on the point 
of a lancet, and introduced into a small puncture previously 
made in the arm. A wafer may be wet and stuck on the 
wound, and every precaution used, to avoid the patient's 
breathing the effluvia of the matter. 

o 

Thus inoculated, the patient is a subject of medical treat- 
ment at once. He is to avoid the extremes of heat and cold, 
live on the poorest fare, and take a mild cathartic once in two 
or three days. With this preparation, carried for eight days 
to the point which is deemed necessary, the small-pox may be 
confidently expected to make its appearance, in a mild form. 
It will seldom require the use of any stronger remedies, after 
the appearance of the fever. The inflammation that afFects 
the arm which has been inoculated, will require the judicious 
application of cold water. In all other respects, the treatment 
will be the same with that which is proper in the milder forms 
of small-pox, when taken in the natural way. 

VACCINATION. 

Vaccination, This is an affection so slight, as scarcely to de- 
serve the name of a disease.. It is performed exactly as in- 
oculation for small-pox. No care is necessary to prevent its 
propagation ; for it is not contagious, except being propagated 
by inoculation, entitles it to that character. It requires no 
general remedies. When the inflammation of the arm is con- 
siderable, and some fever attends it, a free application of cold 
water to the part, with a mild cathartic, and low diet for a day 
or two, may be prudent. No further medical treatment will 
be required. 

This closes what I think it necessary to say, on the awful 
pestilence, small-pox, and its means of cure and prevention. 
On one point alone, could I wish the power of language to en- 
force my advice. It is the prevention of this disease, by means 
of vaccination. The wonders already accomplished by this 



172 SCARLET FEVER. 

invaluable discovery, have hid the monster, small-pox, from 
our view, and we no longer fear him. I have seen enough to 
satisfy me, that the world owes an uncounted debt of gratitude 
to Doctor Jenner, for the devotion of his time and talents to 
the introduction of vaccination. 1 shall never forget the elo- 
quence of Doctor Rush on this subject, or the fervor with which 
he closed this lecture with the following couplet: 

By practice taught, to love the useful plough ; 
With greater cause, " we venerate the CO YvV' 



SCARLET FEVER— SCARLATINA. 

Few diseases appear under so many forms as this. It was 
first described in the seventh century, but not so as to be well 
discriminated from other diseases, until the year 1798. That 
it should have remained so long in this state of obscurity, will 
not appear strange, when we have viewed the disease in the 
various aspects it assumes. 

Scarlatina arises from a specific contagion, and affects per- 
sons but once in their lives. It is true second attacks are 
thought to be frequent ; but, in this case, they are confined 
principahy to affections of the throat, and are perhaps never 
dangerous. 

DESCRIPTION. 

We shall be under the necessitv of describing this disease, 
as it appears in its various forms. 

1. The first we shall notice, presents itself as a light fever, 
with a rash, and a scarlet colored efflorescence of the skin. It 
appears in exceedingly minute points, speedily running to- 
gether and forming a scarlet colored efflorescence; and, bv the 
second or third day, it has extended over a great part of the 
bod}'. In some cases, no symptoms of this eruption are seen, 
and the disease disappears, with a very slight degree of 
sickness. 

2. The next varietv is attended with high fever, and inflam- 
mation of the throat, tending to suppuration. The inflamma- 
tion* in these cases, is very considerable — the swelling very 
great, frequently ending in the discharge of matter from the 
inside of the throat, or the outside, near the angle of the jaw. 
The redness observed on the surface, is characteristic and in- 
tense : perhaps human flesh never gets redder. The suppura- 



SCARLET FEVER. 173 

tion too is very extensive, destroying a great portion of adipose 
substance, and leaving large cavities covered by very thin 
skin. These cases are very dangerous. 

3. The third variety which may be mentioned, affects the 
throat principally, producing large ulcers, exceedingly foul, 
and sometimes gangrenous. The fever attending these cases, 
is considerable ; but they are more characterized by great 
rapidity of the pulse, prostration of strength, pale extremities, 
and other symptoms of malignant disease, and, many times, 
pass without being recognized as scarlet fever. 

4. The fourth variety, I shall term, for the want of a better 
name, malignant. In this, the powers of the patient appear to 
yield without a struggle. The ordinary symptoms of the dis- 
ease do not make their appearance. I have found such cases, 
even from the first, attended with a prostration of strength tru- 
ly astonishing. 1 have seen a child of two years old, unable to 
bear its weight on its feet, within two hours of the attack, and 
a corpse in less than six hours more. It would be, in such 
cases, impossible, so far as I know, to say of what disease the 
patient died, if they did not occur where there were other 
cases of scarlet fever. I have found the stomach, in such ca- 
ses, totally unable to retain any thing, even a few drops of 
laudanum in a tea spoonful of water. Indeed, such cases ap- 
pear wholly unmanageable, and the patient seldom survives 
the third day. 

Such is the variety of symptoms presented by this disease. 
It is therefore not wonderful, that it frequently appears, and is 
not recognized until several cases have occured, and its vari- 
ous symptoms are developed. Indeed it would not be easy to 
believe that the various forms of this disease could be pro- 
duced by the same infection, but for the well established fact, 
that having it in one form, protects the individual against hav- 
ing it in any other. It is also a demonstrated fact, that the in- 
fection taken from a patient, under any of the above forms, 
will produce the disease in any other. 

The infectious character of this disease is well established ; 
but the means of avoiding it are perhaps less known, than that 
of other diseases. Very often it makes its appearance without 
our being able to trace it to its source. In these cases, it is apt 
to spread most, sometimes fully entitling itself to the character 
of an epidemic. Many persons pass through life without ever 
experiencing this disease ; and old persons are almost exempt 
from its attacks. It is uncertain at what stage it is most in- 
fectious ; but it is believed to continue in an infectious state, 



174 SCARLET FEVER. 

long after the individual who has had it has recovered. I have 
myself witnessed several cases, corroborative of this fact. T 
have known one person, who, having had the disease six weeks 
before, at the distance of nearly a hundred miles, propagated 
it in a famify, in a very malignant form. It is, therefore, ex- 
ceedingly difficult to point out measures which may be re- 
garded as securing against the spread of this disease. Judg- 
ing from what I have read and heard on the subject, 1 am in- 
duced to think scarlet fever a much more fatal and common 
disorder in higher latitudes, than that in which I have been ac- 
customed to see it. I believe its first appearance in the State 
of Georgia was in the year 1830, when it appeared to have 
been introduced by some persons who had driven horses from 
Kentucky. Then, and once since, it has appeared in Mil- 
ledgeville ; but, in various parts of the State, it has appeared 
from time to time, and I do not know that the State has been 
at any time entirely free from its presence. I think it is not an 
unreasonable estimate to say, that not one tenth part of the in- 
habitants of the State have ever had this disease. 

Our description of these varieties must be pursued a little 
farther. The first variety is a very mild disease, with a mod- 
erate degree of fever — the eruption appearing on the third day, 
in innumerable small points, diffusing itself extensively over 
the body. On the tongue, the rash appears more distinct. 
Even where that organ is covered with fur, the red points will 
appear through it. The heat of the skin is so great, that it 
must be considered characteristic of this disease. Even in ca- 
ses that have appeared to be mild, I have found the heat to be 
greater than in any other disease. But where the disease at- 
tacks the skin only, it is seldom dangerous, and subsides slow- 
ly after the eighth day — the parts which have suffered most al- 
ways throwing off the epidermis. Where the skin is thick, 
this symptom becomes remarkable — the soles of the feet, and 
palms of the hands, frequently peeling off like paper. 

In the second form, the rash and inflammation of the skin, 
and throat, appear at the same time. The symptoms are al- 
most always severe ; but ulceration and suppuration are fre- 
quently avoided. In these cases, the pulse is rapid, the 
tongue dotted red, the rash appears later, and recovery is 
slow. Frequently the stomach and bowels are very much dis- 
ordered. 

It is rare that we meet with a case so malignant, as to hur- 
ry off the patient, before any part of the local disorders we 
have alluded to, make their appearance. The scarlet tint of 



SCARLET FEVER. 



175 



the skin, or ulceration of the throat, appears even in the worst 
of cases. The eruption however feeble, is not pale, but 
purple, sometimes with a tint of bright purple, unlike any 
thing else I have seen; but the prostration of strength, vomit- 
ing, dark red color of the throat, gangrenous ulcers about 
the fauces, and the rapid course of this form of the dis- 
ease, will prepare the physician to expect the worst. The 
deceitful character of the disease is also complained of by 
medical writers. Cases which appear mild, and progress for 
several days without an unpleasant symptom, suddenly change 
into the most malignant forms, and end in speedy destruction. 
The tendency to suppuration, in this disease, is very great. 
It most frequently occurs about the neck and throat, and in the 
ears and other adjoining parts ; but sometimes suppuration oc- 
curs in the limbs, and especially in the joints, presenting per- 
haps the most obstinate form of this disease. 

The ills we have described, are not all that belong to scarlet 
fever. Frequently the disease seems to have terminated ; but 
local inflammations of various organs follow. The eyes, the 
ears, and the lungs come in for their share of these disorders. 
Dropsy also is a frequent sequel of this disease; but it is said 
that it never occurs after the malignant form. After all that 
has beeu said, we have much to learn in reference to scarlet 
fever. We have, many times, epidemic disorders which pass 
under the terms of quincy, ulcerated sore throat &c, in which 
there is no eruption of the skin to identify them with scarla- 
tina; and yet, in other respects, their symptoms are the same. 
Indeed I know no way of discriminating one from the other, 
except by their attacking persons who had scarlet fever, or 
individuals at the same time suffering other forms of that 
disease. 

The danger attending any particular case of scarlet fever, 
is, in the first place, in proportion to the malignity, or pros- 
trating power of the attack. This sudden and great prostra- 
tion will always warn us of danger; but, in cases where the 
local injuries are extensive, and where the strength of the pa- 
tient, in the first stage of the disease, seems to be well sus- 
tained, the danger will be in proportion to the extent of the 
local injury. For instance, the abscesses about the throat and 
other parts of the body, may, of themselves, produce great 
danger. I have found them but little inclined to heal, and 
many patients sink from the excess of discharge from them. 
The ulcerations, especially when dark colored and gangrenous, 
in the throat, are also significant of danger. In other respects, 



176 SCARLET FEVER. 

or when the symptoms are milder, scarlet fever is a mild dis- 
ease. I have seen forty persons attacked with it without a 
single serious case ; yet, at other times, almost every person 
attacked in a family will perish. We have been told that in 
Paris, in 1743, an epidemic scarlatina carried off every per- 
son who was attacked with it. My own experience in it 
has been such as to cause me to dread it more than small-pox. 

TREATMENT. 

In the milder forms of scarlet fever, the treatment is ex- 
ceedingly simple. The disease is purely inflammatory, and of 
a grade in itself not dangerous; yet our fears are not to be 
lulled into such security as to hinder our watchfulness; for the 
disease, however mild, sometimes puts on alarming symptoms. 
Abstinence from food, or taking food of the lightest character, 
should always be the first rule. Light cathartics, seidlitz 
powders, castor oil, or calcined magnesia, answer very well. 
If there is great heat of the skin, lessen that heat by sponging 
with cold water ; and here let me remark, do not be afraid of 
cold water. The sensation of the patient will direct the time 
at which it should be discontinued. Commonly it is sufficient 
to apply it to the extremities, the legs, and feet, arms, hands 
and face. Half an hour or perhaps an hour, will be long 
enough to make the application at one time. But if the ex- 
tremities become pale under its use, it is to be laid aside, and 
returned to, from time to time, as the circumstances shall seem 
to require. For in this disease, I repeat it, it is safe to keep 
down the heat by the application of cold water. 

Where the stomach is much affected with sickness, and 
cathartic medicines are thrown up, an emetic, of ipecac may 
be given ; and where the symptoms are of higher grade, the 
antimonial mixture, made by putting two grains of tartar eme- 
tic and two drachms of nitre into half a pint of water, may be 
given hourly — a tea spoonful to a child of six years old, as 
long as the symptoms appear to require it. 

The second, or more violent order of cases, we have seen, 
attacks not only the skin with an extensive eruption, but the 
throat with ulceration, and perhaps extensive swellings and 
suppuration in other parts of the body. No disease can be 
more intensely inflammatory, or require a more decidely de- 
pleting course of treatment. Bleeding will of course be prop- 
er, in the first stage. But it is not always in our power to re- 
sort to it, at the time it would be most beneficial ; for it should 



SCARLET FEVER. 177 

be done even before the eruption appears. Emetics are thought 
to be peculiarly efficacious; and, except it be a very small 
child, a decided preference should be given to taitar emetic. 
Cathartics are also used ; and of these the best, I have no doubt 
is calomel. A daily cathartic has been recommended during 
the stage of inflammation, and preceding the formation of mat- 
ter. My own opinion is, that the cathartic should not be re- 
peated so often; but that the antimonial mixture, above de- 
scribed, should be used, from time to time, according to cir- 
cumstances. Leeches, cupping, scarification of the tonsils, 
and other remedies for the removal of local inflammation, have 
also been recommended. The application of cold, in these 
cases, has also been highly extolled ; and I concur fully in the 
opinion, that they are exceedingly important. All these reme- 
dies which tend to exhaust the system, are to be pursued 
with that judgment which shall always remember, that the 
strength of the patient should not be too far relied on. After 
the free operation of these remedies, the irritation, pain, rest- 
lessness, and other symptoms frequently call for the use of 
laudanum. A single sufficient dose is the best mode of using 
it — sixty to eighty drops to a grown person, and a smaller dose 
to children according to age. This may be required daily, or 
twice a day, for several days, from the time the ulceration of 
the throat, or suppuration takes place. 

As soon as suppuration has taken place, the rules of the 
treatment change, and every means of support becomes neces- 
sary. Food is gradually to be made even a remedy, spirits or 
wine also become necessary, and other tonic medicines are to 
be used, according to the strength of the patient. 

The malignant form of scarlet fever, when it is fully de- 
veloped, admits of no treatment with any prospect of success. 
I have never seen a single case, with the decided symptoms I 
have mentioned above, recover. Indeed it is perhaps nearly 
impossible to administer to them any remedies. Every thing 
is rejected from the stomach, and external remedies have 
proved equally fruitless. 

The local disorders which follow scarlet fever — inflamma- 
tion of the ear, eye, &c, require the treatment which inflam- 
mation of those organs from other causes require. But there 
is one sequel of this disease which requires particular notice. 
Dropsy frequently follows even the mildest cases ; and this 
dropsy is frequently obstinate and alarming. I have found the 
most active treatment the best. Cathartics of jalap and cream 
of tartar, every second day, have arrested these cases, under 
12 



17 S MEASLES. 

my observation, with safety and success. This is a common 
remedy in dropsy ; but it is especially recommended here be- 
cause it would naturally be supposed that a patient, running 
into this disease from so formidable a disease as scarlet fever, 
would be too feeble to b ear so strong a remedy. My own ex- 
perience is, that dropsy, after scarlet fever, is as inflammatory, 
and requires as active treatment, as when it arises from any 
other cause. Should it prove obstinate, the other remedies re- 
commended in dropsy should be used. 



MEASLES— RUBEOLA. 

This is a contagious disease affecting persons but once in 
their lives. For a long time it was confounded with scarlet 
fever, and many persons were supposed to have had that dis- 
ease more than once, and it is but lately that the discrimina- 
tion between these two diseases, has been at all perfect. It is 
perhaps the most uniformly inflammatory of all eruptive dis- 
eases. It has never, within my observation, assumed the ma- 
lignant character, and produced the great prostration so fre- 
quently met with in small-pox and scarlet fever. 

DESCRIPTrON. 

In its attack, mild cases of measles are scarcely to be dis- 
criminated from a common cold. It produces the same sneez- 
ing, suffusion, or running at the eyes, chilliness, cough, &c. 
Cases of greater violence occur with a chill rather protracted, 
and are felt mainly when the patient is exposed to cool air. Fe- 
ver supervenes, with the ordinary S} 7 mptoms of inflammatory 
disease, headache, and pains in the back and limbs. The 
stomach and bowels too, are very much affected with great 
nausea, vomiting, griping pains, diarrhoea, &c. The fever 
which attends this stage of the disease, is violent in proportion 
to its degree ; and is an index to the danger which may be 
expected. The lungs too are very much affected in this dis- 
ease, but the pain which exists in these organs is slight ; but 
in all this, the characteristic symptoms of the disease, are not 
seen. It could not be known for measles, except for the affec- 
tion of the skin, which is to follow. The rash which consti- 
tutes the most certain symptom of this disease, appears on the 
third or fourth day — sometimes later. At first the eruption 



MEASLES. 179 

has the appearance of fleabites, principally on the lace. 
Fiom this they spread over the body, and, about the fifth day, 
have acquired their greatest height. No tenderness or symp- 
toms of violent inflammation attend them ; but when they are 
very numerous they thicken the skin, and, in many cases, the 
eyelids, ears, and face, are so much swollen, that the individu- 
al could scarcely be known. No ulceration however follows, 
nor, so far as I have seen, the slightest formation of matter of 
any kind. Authors say that the first appearance of this erup- 
tion may be recognised by the rash, appearing in a semi-lunar 
form — several points near together, in various places, taking 
up that appearance. This has not appeared to me so uniform, 
as to make it an unerring mark of the disease. I discriminate 
it from scarlet fever, from its total inaptitude to form matter; 
and, especially, on its occurrence in the form of a common 
cold, affecting the lungs apparently as much as the skin. Af- 
ter the sixth day, the rash gradually disappearing, where it has 
been severe, the cuticle will peel off like branny scales. 

I have said that measles is a contagious disease ; and the 
evidences of its being so, are as full as those met with in almost 
any other disorder. Still, it is extremely difficult to point out 
the circumstances under which this contagion spreads. Many 
individuals contract k, and going to a distant place, it breaks 
out, and does not spread in the families into which they have 
thus carried it: in other instances it seems to have been propa- 
gated in this way. I have witnessed the case of an individual 
attacked with the fever, and, in this slate, on the second day 
of the attack, restingat an inn for the night, and proceeding on 
the next day a few miles, to her own residence. In the house 
at which she staid the second night ot^ the attack, the measles 
broke out, affecting every one liable to receive it ; but in her 
own family, where she had arrived about the time of the erup- 
tion, and remained to the end of the disease, it did not spread ; 
although every opportunity was giyen to propagate the infec- 
tion, to several others who were liable to it. This would seem 
to be good evidence, that this infection is chiefly propagated 
by patients while in the stage of fever, and previous to the ap- 
pearance of the eruption. 

It is important to be able to discriminate measles from scar- 
let fever. This is done more by its resemblance to a common 
cold, than any thing else — at least in the first stage of the dis- 
ease. But there is, in the eruption itself, a very marked dif- 
ference from scarlet i'ever. Mottsles appears at first in dis- 
tinct dots, appearing, as it were in little patches. It may be 



180 MEASLES. 

felt, especially on the face and arms — the skin having, on these 
parts, considerable roughness. In bad cases, the eruption is 
distinctly seen in the mouth, especially far down the throat. 
The impression made on the skin, leaves a clouded and indis- 
tinct remnant of the eruption, for a considerable time. 

It would be impossible to enumerate the various combina- 
tions of symptoms, which maybe met with in this disease. Its 
violence is sometimes so great, as to produce delirium, and 
convulsions ; and the swelling of the face, and even of the 
hands, is sometimes very considerable, but with no tendency, 
as above stated, to suppuration. The bowels and the stomach 
come in also for their share of the most violent and dangerous 
symptoms of this disease. The spontaneous diarrhoea and 
griping pains, although but little noticed by authors, have, in 
my practice, been the most troublesome and dangerous symp- 
tom. Profuse perspiration also attends some cases, and has, 
within my observation, produced the greatest and most dan- 
gerous prostration. 

TREATMENT. 

The first rule to be observed in the treatment is, to avoid 
the extremes of heat and cold. I have never found it neces- 
sary to resort to artificial heat,, to sustain my patients,, in the 
first stage of measles. Laid in bed, and covered with the or- 
dinary clothing, I have always found them sufficiently warm ; 
yet should the case assume a malignity which I have not seen, 
and the extremities remain cold, with an exceedingly feeble 
circulation, 1 should not hesitate to apply warmth and such 
moderate stimulants as would, in other respects, appear ad- 
missible. The next maxim as to management is, to avoid ex- 
posure to too much light The tenderness of the eyes fre- 
quently indicates, with sufficient plainness, the necessity of 
this rule. These maxims being well observed, and the patient 
kept on a very low regimen, most cases of measles require no 
other remedy ; but there are many eases in which this practice 
would be too inefficient. 

When the disease attacks the lungs with symptoms of con- 
siderable inflammation and pain, or affects the head with in- 
tense pain, bloodletting and other general remedies for the re- 
duction of inflammation and fever, become necessary. Few 
cases require the use of the lancet ; but sometimes the majori- 
ty of the cases which will present themselves, should not be 
allowed to exhaust themselves without the interposition of 
remedies. If the fever is high, gentle cathartic remedies may 



MEASLES* 181 

be safely used. Calomel, succeeded by castor oil, is probably 
the best. Where the stomach is affected with nausea, and the 
bowels not much affected, I have no hesitation in giving emet- 
ics. Ipecac is piobably the best of these. The remedies will 
hardly require to be repeated ; and commonly the administra- 
tion of a single dose is all the case will require. 

I have stated that a due medium was to be observed, in the 
application of cold to the skin. This rule is generally good, 
till the eruption on the face has fully appeared. When this 
stage has arrived, and the heat and oppression are ver}' great, 
I have no hesitation in recommending the application of cold 
water to the face and extremeties. This is considered by the 
highest authority, a doubtful practice ; but my own experience 
is decidedly in its favor. The measles, in this stage, cannot 
be expected to keep up great heat in the skin, for a great length 
of time ; and therefore the term during which cold applica- 
tions are admissible, will be short, never more than one or two 
days. Nor should it be continued throughout any day; half 
an hour, or an hour at a time, is as long as it will be neces- 
sary. 

Sometimes the eruption suddenly disappears, and the illness 
of the patient appears very much increased. Opiates are, in 
these cases, by far the best remedies. Laudanum, in doses 
suitable to the age of the patient, may be given once or twice 
in the twenty-four hours. Warm bathing of the extremities, 
applications of mustard or other stimulants; and, in extreme 
cases, the internal use of spirits, camphor, or other strong 
stimulants become necessary. 

The persons most subject to attacks of measles, are of an 
age at which a great deal of discretion cannot be expected. 
Children frequently run in the open air, even in cold weather, 
with a fever which is to end in an eruption of this disease ; and 
I have frequently observed them to get well as readily, as 
those who had been most carefully attended. Sometimes, 
however, the symptoms are greatly aggravated, and the erup- 
tion hindered, the patient at night having symptoms of great 
oppression. If the lungs are not too much affected, and the 
case attended with great fever, I administer opiates — lauda- 
num in doses suited to the age of the child. This reme- 
dy I have found exceedingly useful in allaying the irritation of 
measles. Many times it will allay the most troublesome cough, 
and is our principal reliance where the bowels are affected 
with much pain. It should be recollected, that in treating this 
disease, we are contending with that which of itself cannot last. 



182 R0SEOI,A. 

If we combat successfully the present symptoms, time and the 
natural course of events will do the rest. 

I have said that measles is seldom a dangerous disease ; and 
when occurring by itself, and in weather not too hot or too 
cold, I have seen few exceptions to this remark. Certain 
complications of the disease are, however, much to be dread- 
ed. It frequently attacks children who have not yet recovered 
from hooping-cough; and these cases I have found exceeding- 
ly dangerous ; yet there is but little to be added in regard to 
the treatment of such cases. The rules above given are still to 
be adhered to. 

The diarrhoea which sometimes succeeds measles, requires 
no peculiar treatment. It is to be treated as that disease when 
it arises under any other circumstances. But the most obsti- 
nate and dangerous of the diseases which follow measles, are 
those which attack the lungs. They require patient watchful- 
ness and care — no remedies that I know of, differing trom 
those applicable to coughs in general ; but the patient is to be 
managed, in these cases, with a. view to the peculiar obstina- 
cy of the disease. The remedies used should be mild, bu£ 
the patient should be particularly protected from exposure to 
fatigue or cold. 



ROSEOLA. 

This disease is known by a slight rose colored efflorescence? 
extending widely over the surface, and attended with a mode- 
rate degree of fever. It is not contagious, and is of rare occur- 
rence ; but whether liable to affect the same person more than 
once, has not been well determined. It would be of little con- 
sequence to notice it, but that its resemblance to scarlet fever 
and measles, is such as to render it, in some cases, doubtful 
whether it is not one of those diseases. Like scarlet fever, it 
sometimes affects the throat to a considerable decree. A 
rash, sensibly felt with the hand, appears on the skin, succeed- 
ed also by a rose-colored efflorescence. In this disease, this 
efflorescence recedes and reappears, without any remarkable 
change in the situation of the patient — differing in this respect 
from measles or scarlatina. The skin also is left without any 
liability to be thrown off, as in the other diseases we have men- 
tioned. Neither has roseola the catarrh, or common cold, 
which is the common symptom of measles. 

Roseola is commonly a disease of infants i yet it, ia some 



CHICKEN-POX. 183 

cases, attacks persons of any age. An eruption exactly like 
it, sometimes occurs in persons laboring under small-pox ; but 
it, no doubt, in those cases, belongs exclusively to that dis- 
ease. It is known also from other mild eruptive diseases, 
from having: a decided rash or roughness on the skin. It sel- 
dom lasts more than five or six days, and is almost never at- 
tended with any danger. 

TREATMENT. 

Rest, a low regimen, and mild laxative remedies, form per- 
haps the only treatment required in this disease. It will dis- 
appear in a reasonable time; and no unpleasant consequences 
need be apprehended. 



CHICKEN-POX— VARICELLA. 

This is a slight disease, liable to occur to the same person 
but once in life. It would be scarcely necessary to treat of it, 
but that its resemblance to small-pox, is sometimes a cause of 
unpleasant or dangerous mistakes. 

DESCRIPTION. 

It is doubtful whether the eruption in chicken-pox, is pre- 
ceded by any fever. When it is brought to our notice, a few 
vesicles are found in various parts of the bod} r , about the size 
of a split pea, containing a watery fluid. Some degree of fever 
will at this time be noticed. These vesicles are generally dis- 
tinct ; but, sometimes, in certain parts, they are found so near 
as to run together, forming a blister of considerable size, which 
ends, however, in a short time, in a dry scab, and thus termi- 
nates without further mischief. The skin below appears to be 
but little affected ; yet there is, in many cases, a scar of some 
extent left, resembling in some degree the pit of small-pox. 

The contagion of this disease must be considered strong ; 
for few persons live without experiencing it; yet there has not 
occurred, within my observation, a single case in which any 
serious mischief has resulted from it. 

TREATMENT. 

After what has been said of the slightness of this disorder, 
a very few words are sufficient in regard to its treatment. 
There is, it is true, a certain decree of fever attending; it ; and 



184 INFLAMMATION. 

the patient should avoid fatigue, or other circumstances which 
might aggravate the symptoms of fever. Alow diet, and some 
gentle purgatives, may be used where the patient seems to be 
affected with fever. Further use of remedies would seem to 
be uncalled for. 



INFLAMMATION. 

A general knowledge of the subject of inflammation, is so 
essential, that it would be difficult to set a limit to this work, 
which should not require it to be treated of in a separate chap- 
ter. It is true, we shall be compelled to refer to it, as the lead- 
ing symptom or cause of many diseases; but it occurs under 
so many circumstances, and is so often the subject of treat- 
ment, that I consider it necessary to treat of the subject some- 
what at large. Pain, redness, heat, and swelling, have been 
considered the essential characteristics of inflammation, from 
a very early age. These symptoms begin, attend, or con- 
clude, nine tenths of the inflammatory diseases with which 
men are afflicted ; but inflammation is not always to be con- 
sidered, an unfriendly or destructive agent. On the contrary, 
diseases appear, many times, to lead essentially to it, and to 
end in it under the most favorable circumstances. So sensi- 
ble are physicians, of the benefits of inflammation, in many 
instances, that many of their remedies are directed to its pro- 
duction. The terminations of inflammation are various, reso- 
lution, suppuration, and gangrene, being the most common. 

In considering inflammation, we are first directed to the va- 
riety of pain which attends it — in some instances prickling, 
tingling, smarting ; in others, sharp, lancinating ; and some- 
times with scarcely any pain. But perhaps the most common 
pain which attends inflammation, is that which is attended by 
throbbing, producing pain at even' pulsation. 

The great sensibility of the skin, makes it the source, in ma- 
ny instances, of the keenest pain. Inflammations which oc- 
cupy the skin, are fully as painful, as those which occupy any 
other tissue of the body. Distension also from the swelling, is 
of itself a great cause of pain. The motion which in some ca- 
ses is unavoidable, is often the principal cause of the pain 
which attends inflammation. Yet all this variety of pain seems 
not to depend on the sensible qualities of inflammation ; for 
we have many examples of great inflammation without pain . 






INFLAMMATION. 185 

Moreover, a paralysis of the nerves which lead to the part, 
produces insensibility which hinders pain, in spite of the pres- 
ence of any degree of inflammation. 

The heat which attends inflammation, never exceeds that of 
the circulating blood. On this head deception is very easy. 
By laying the hand on the part, the heat will at sometimes ap- 
pear very great ; but the degree of that heat will be found, on 
investigation, to be no greater than that of the blood of the pa- 
tient- If, therefore, the heat is greater than the ordinary heat 
of the body, it will be found, on investigation, that some de- 
gree of fever attends the case. 

The redness is owing to the increase of blood in the part. 
This increase of red blood, seems to be provided for, in the 
process which attends the swelling of the part. The minute 
vessels which usually transmit only the water}' portions of 
blood, become now enlarged, and transmit red blood. Nor is 
it doubted, that, in these cases, new vessels are formed winch 
transmit also red blood, and serve to augment the swelling. 
The aspect of a part in a state of inflammation, varies with all 
the shades of redness. In some instances, it is of a livid, pur- 
plish tint ; and the blood seems really to pass through it very 
sluggishly; but, in other cases, the color is of a bright scarlet, 
and the blood appears to circulate with much greater rapidity. 
The deep seated organs which are beyond our investigation, 
as to color, have, no doubt, the same accumulation of blood, 
and the same change in this respect, which is witnessed on the 
surface. Dissection has placed this beyond a doubt. There 
may be redness without inflammation ; and this will come un- 
der the observation of any one, who will notice a part which 
has been inflamed, and, in some degree, disorganized a short 
time after that event. A degree of redness will remain for a 
shorter or longer time. 

The swelling which attends inflammation, is perhaps the 
most interesting to be considered, in reference to the whole 
matter. Generally, it has been considered, altogether cura- 
tive in its character. By some unknown law, as soon as a 
part becomes inflamed, the blood throws out coagulable lymph 
or albumen into the flesh. This coagulable lymph acquires 
a solidity and firmness, which give rise to the hardness or firm- 
ness of particular organs, witnessed only in inflammation. This 
firmness and resistance — probably the greatest cause of pain, 
serve yet to limit the spread of the disease. When the inflam- 
mation goes through its most common course, and forms pus 
in the centre of the part, this pus is hindered from spreading 



1S6 INFLAMMATION. 

and entering other organs, and thus producing incalculable 
mischief. The nature of the parts affected, limits the extent, 
and generally causes the particular character of this swelling. 
In some parts, visible swelling is impossible — for instance, in 
the bones. The presence of inflammation, is, in such cases, suf- 
ficiently indicated by the presence of the rest of the symptoms 
of this disorder. 

Much has been written to assign a cause for the happening 
ofinrlmamation, in any particular part. Wounds, bruises, lb- 
reign matter thrust into the flesh, and other similar causes, are 
obvious to all. Exposures to cold or to heat, are also obvious 
causes ; but, in the great majority of the cases in which we 
meet inflammation, we search in vain for any cause from which 
it should have happened, in any particular spot. Writers, it 
is true, have seen or fancied, that there was a congestion in the 
part, which preceded the inflammation that was soon to occur. 
Of this, I confess. I have seen too little to give any opinion. 

One of the most common consequences of inflammation, is the 
prod uction of pus or matter. This substance, differing so wide- 
ly in its appearance, from the blood, is, nevertheless, a product 
from that fluid. It has, on examination with a microscope, a 
much closer resemblance to the blood, than would at first ap- 
pear. Pus is formed of globules, as well as blood ; and some 
have thought, and with great plausibility, that pus is identical 
with the red globules of the blood, except that it is divested of 
its coloring matter. 

The watery portion, or serum of the blood, is seperated from 
it, in some instances of inflammation. It is seen to transude or 
exhale from the surface of membranes which are inflamed. It 
is also in this way, that the water or fluid, found, many times, 
in the cavities of the body, and constituting dropsy, has arisen. 

Ulceration, or the absorption of inflamed parts, is another 
termination of inflammation frequently met with. This is the 
particular obstacle to the healing of ill conditioned ulcers, and 
will come under our notice, when cases of this kind are treated 
of. But it may be well to notice here, that not only the skin 
and adjoining parts are absorbed, in this way, but fat, and even 
bone, is subject to this curious process. The repairs which 
nature performs, in parts which have been subjected to the de- 
stroying influences we have been considering, are worthy of a 
passing notice here. Not only are parts filled up after they 
have been destroyed by inflammation, but new blood vessels, 
and new absorbants, are formed in these new parts. The 



INFLAMMATION. 187 

coagulable lymph which we have mentioned above, is the 
great agent of this repair. 

Inflammation is rarely present without inducing some gene- 
ral disease of the bod} 7 . If it is extensive, the fever which at- 
tends it, becomes manifest, and the blood drawn exhibits the 
buffy coat so characteristic of this state of things. This state 
of the blood is exceedingly important to be noticed ; for it not 
only enables us to judge of the proper treatment of a visible 
inflammation, but is our best evidence, in many instances, of 
the presence of inflammation which we cannot see. Still, this 
state of things is not always present when there is inflamma- 
tion ; for the variety of this affection, both as to its phenomina, 
and its latent or unknown causes, is beyond estimation. It is of 
some consequence, that, in looking for the presence of this 
state of blood, it should be drawn in a full stream, in a vessel 
of some depth — for any variety in the mode of its abstraction, 
changes its parts wonderfully. And, after all the investiga- 
tion which has been given to it, this is a sign that not unfrequent- 
ly misleads us. It may be considered however as settled, 
that the stronger the contraction of the buffy coat, and the more 
cupped its surface, the higher is the grade of inflammation. 
On the contrary, if the contraction is weak, and the blood, af- 
ter it has stood for a length of time, is easily broken, the in- 
flammation will have but a slight tendency to the formation of 
pus. The blood, in these cases, has the appearance which 
has been termed iris — resembling the rain-bow, and is suffi- 
ciently characterised by its appearing of a mixed bluish and 
red mingled together. It has been asserted, that mere ple- 
thora will frequently produce a buffy state of the blood. This 
I consider extremely doubtful. My own impression is, that 
there is a present inflammation in these cases ; and that the 
appearance of this state of the blood in pregnant females, ap- 
parently otherwise in health, forms no exception. 

Inflammation, however excited, tends to some particular 
termination ; and the various modes and manners in which this 
happens, have been a matter of deep thought and investiga- 
tion. The most common of these has been termed resolution, 
by which we mean a gradual disappearance of the inflamma- 
tion, leaving the part sound and unhurt; and this we may con- 
siderthe most favorable of all the terminations of inflammation. 
There is another termination, very liable to be mistaken for 
this; and, from some unknown law of nature, it occurs more 
frequently than we at first might suppose. 1 It is called metas- 
tasis, by which we mean, a transfer of inflammation from one 



188 INFLAMMATION. 

part of the body to another. This occurs very frequently in 
gout and rheumatism. These diseases, leaving one part of 
the body, without evident cause, are transferred, perhaps 
w.ithin a few hours, to another and distant part. 

Another termination of inflammation has been termed ex- 
travasation. This term signifies a throwing into the sur- 
rounding substances, fluid matter, probably the serous portion 
of the blood, whereby the part appears to be attacked with 
dropsy. The inflammatiou at the same time declines. This 
sometimes occurs in the most important organs of the body, 
in the lungs, or perhaps the brain. 

The effusion of coagulable lymph in an inflamed part, we 
have mentioned. But its importance justifies a further notice 
of it. This lymph, transparent and fluid, at first hardens, and 
becomes as it were dry. It is the great cause of the hardness 
of inflamed flesh. When thrown into the flesh, it, man}^ times, 
abides for a great length of time, productive of little or no in- 
convenience. This is more particularly the case in inflamma- 
tion of the joints, and other ligamentous and tendonous parts of 
the body. The eye also is subject to a very common injury 
from this cause. The spots formed on the transparent por- 
tions of the eye, arise from a deposition of coagulable lymph 
in that membrane. This substance is not only thrown out into 
the solid parts of the flesh, but is sometimes thrown out on the 
surface of inflamed parts. The membrane surrounding the 
heart is a very common seat of this occurrence. It occurs 
also in the cavity containing the lungs, producing, in many in- 
stances, an adhesion of the lungs to the side, which never gives 
way during life. The same thing occurs in the wind pipe. 
The common disease croup, sometimes becomes as it were 
chronic ; and, by the inflammation attending it, a membrane is 
formed of this matter which is commonly destructive of life by 
suffocation. In a few cases, however, it is coughed up, and. 
the little sufferer escapes after a protracted struggle. The 
lining membrane of the intestines is also subject to this acci- 
dent. In dysentery a considerable portion of the lower in- 
testine, is sometimes lined with this lymph, which forms into 
a strong membrane, and is discharged, presenting a substance 
resembling a portion of the intestines. I have been seriously 
informed by an individual, that she had discharged a portion 
of her intestines nearly a foot in length. 

We are not done with the effects of lymph, thrown out in the 
process of inflammation. It is the great bond of union between 
parts of the body, which have been divided by wounds. It is 



INFLAMMATION. 189 

the great balm of nature, by which the healing process has 
been made possible. Thrown into the flesh and surrounding 
inflamed parts, it limits their extension, and thus makes a safe 
receptacle for that formation of pus which might, by entering 
the circulation prove fatal. It is therefore a great object to in- 
duce, in wounds, the throwing out of this matter. And there 
is a degree of inflammation suited to this object ; but a great- 
er or less inflammation in many cases hinders the healing of 
wounds. 

Suppuration or the formation of pus, is a common termina- 
tion of inflammation. Pus, when light colored, smooth, ino- 
dorous, and about the consistence of cream, is called healthy, 
because the production of such pus is the best evidence that 
the part which has produced it, will readily heal. The com- 
mon course of inflammation is to throw out lymph first, and 
pus, next. In the solid parts of the body, the pus makes for 
itself, a chamber or cavity, from which by the absorption of 
the parts commonly towards the surface of the body, it gradu- 
ally progresses, till it bursts and escapes. It is not always, 
however, that pus presents the above appearance. It is some- 
times thin and watery, having the appearance of oil ; and, in 
such cases, we do not look for so favorable a result. It is com- 
paratively harmless however, so long as the air is excluded ; 
but so soon as it comes in contact with the atmosphere, pu- 
trefaction commences ; and, from this cause, wounds become 
exceedingly offensive. Something seems to depend on the 
part of the body in which pus is formed. When near the in- 
testinal canal, either in the liver or near the rectum or anus, 
pus, without any other obvious cause, becomes exceedingly 
offensive. I have discharged many such abscesses, which 
have healed without difficulty, notwithstanding the great of- 
fensiveness of the matter discharged. 

Ulceration is most common in the skin, and depends on the 
absorption which has been caused by a high degree of inflam- 
mation. But it occurs also in other parts of the body ; arte- 
ries and even bones are subject to ulceration. It is more rare 
in fibrous or serous tissues, such as the lining of the lungs, and 
the ligaments about the joints. Yet all these parts are subject 
to be penetrated by pus, when it originates in such a situation 
that it cannot readily escape through other tissues. Heal- 
ing is opposed by absorption, by sloughing, or by fungous 
flesh. 

Finally, we arrive at the last dreadful end of inflammation, 
mortification, or death, in the part affected. And here the 



190 INFLAMMATION. 

powers of nature to overcome a commencing death of the body, 
stand up and claim from us a high degree of admiration. The 
mortified part is instantly surrounded by a barrier of coagula- 
ble lymph, which hinders the putrid matter from passing into 
the circulation of the blood. Ulceration instantly commences 
to surround this dead mass with a furrow, and to cut it off 
from all connexion with the living flesh. Nor does it matter of 
what the dead part may be composed, be it flesh, be it skin, 
be it bone, nature instantly sets about the work of cutting it off. 

The inflammation of internal organs, is the great foundation 
of many diseases. Here we are hindered from that inspection 
which would enable us to decide on its character and danger. 
The symptoms which it produces, have been a matter of deep 
study and investigation ; and here, above all others, has the 
dissector, in his post mortem examinations, lifted the vail from 
this obscure subject. The physician now goes forward with 
a great degree of confidence, that he understands these dis- 
eases. The leading symptom which attends them, is fever ; 
and fever which has been termed inflammatory, for the good 
reason, that it is produced by inflammation. It is, many times, 
uncertain whether the fever has preceded the inflammation, or 
the inflammation the fever. One thing, however, we should 
bear in mind, that the importance of the case does not depend 
upon the degree of fever which attends it. Organs absolutely 
essential to life, being, many times, inflamed without produ- 
cing any great degree of fever. As a general rule, the fever is 
higher in young and pleth.iric persons ; but it is modified by 
the organs affected, and by the habits of the patient. In these 
deep seated inflammations, suppuration often occurs ; and then • 
it is, that a remarkable change in the character of the fever 
takes place. Chilliness, followed by a decline of fever, with 
profuse perspiration, renewed at irregular intervals, great de- 
cay of strength, increase in the rapidity of the pulse, and other 
symptoms of prostration attends. Indeed the case becomes, 
a hectic fever. 

Great is the variety of inflammation, as it makes its appear- 
ance in the various tissues of the body. Abscess, a common 
consequence of inflammation, is most commonly seated in that 
membranous organization, immediately below the skin, ordi- 
narily containing fat. The occurrence of suppuration in these 
parts, may be judged of by the touch. To hardness succeeds 
softness, and evident fluctuation of matter. The serous mem- 
branes, such as the lining membrane of the lungs, are seldom 
subject to suppuration. Here the inflammation runs high, the 



INFLAMMATION. 191 

pain is intense, and the blood showing the highest degree of 
inflammation ; yet the tendency is not to the formation of mat- 
ter, but to the thickening and adhesion of the lining membranes. 
The joints also resist the formation of matter, in a remarkable 
degree. This is witnessed in rheumatism, and indeed after 
injuries which may have resulted in a high degree of inflam- 
mation. It is only when air is admitted into the cavities of the 
joints that they readily produce pus. The skin is perhaps sub- 
ject to the greatest variety of inflammatory disorders. We 
have said that it is a seat of intense pain ; this however is by 
no means always the case. The internal teguments of the 
lungs, bowels, &:c, do not readily form matter ; but, on the 
contrary, are much more apt to adhere, or to pour out mucous 
or serum. Muscular fibre is very little subject to inflamma- 
tion. 

Arteries and veins are very common seats of inflammation ; 
and very different indeed, is the result of this affection, when 
thus seated. The artery seems to have power to throw off this 
enemy of its organization. The coagulable lymph will close 
its pores, and soon bring the disease to a favorable result. In 
the veins, however, the case is very different; suppuration in 
these vessels, is exceedingly dangerous. The pus finds its 
way into the blood, circulates through the whole body, and is, 
many times, destructive of life. 

Inflammation has been divided into two great classes — the 
acute and chronic. The acute, with symptoms of great vio- 
lence and rapid progress — the chronic, with symptoms mild 
and slow. Between these great classes no exact line can be 
drawn ; nor is it of much consequence in a practical point of 
view. Acute inflammation runs to a speedy termination, and 
developes the danger at once ; but chronic inflammation may 
be none the less dangerous for its slow progress. Indeed it 
is this form of inflammation which produces the greatest 
change in the substance it attacks — such as hardening, thick- 
ening of membranes, pus, serum, &c. There is an inflamma- 
tion which has been called latent, because it is unattended 
with pain, and productive of none of the ordinary symptoms of 
inflammation. Except for the lately invented system of in- 
vestigation by auscultation, these diseases, when they attack 
the deeper seated organs, would remain unknown during the 
lifetime of the patient. With these aids, they are no longer 
allowed to remain totally unobserved. In the ordinary classi- 
fication of inflammation which has been made on the rapidity 
of its progress, there are varieties which depend on the spe- 



192 INFLAMMATION. 

cific character of the disease in which it occurs. The inflam- 
mation produced by small-pox, differs widely from that pro- 
duced by measles, and this again is widely different from that 
produced by erysipelas. But, the most important of the chro- 
nic inflammations, is that which attends scrofula — a disease in 
higher latitudes exceedingly common, but in this country, com- 
paratively rare. This inflammation is characterised by its 
slow progress, and especially by the curdy matter seen in the 
fluid pus discharged from it. Its progress, it must be confes- 
sed, is too little influenced by remedies. This form of inflam- 
mation attacking the lungs, is thought to be almost the sole 
cause of consumption. 

Scrofula is considered a hereditary disease, and the subjects 
of it are thought to inherit a temperament which may be known 
by the appearance of the individual. This temperament has 
obtained the name of leucophlegmatic — characterised by a 
pale, pasty complexion, large head, narrow chest, large belly, 
soft muscles, and feeble circulation. Within the range of my 
observation, this temperament has not been so conspicuous, as 
it is represented to be in higher latitudes. I do not know that 
I should be able to point out a single individual, in childhood, 
whose growth and maturity would necessarily lead to con- 
sumption. 

It is not my purpose in this place, to treat of the many dis- 
eases founded on inflammation. Most of these will require a 
separate consideration. For the present, I shall satisfy myself 
with pointing out the general remedies for this disease, leaving 
the details of treatment for particular cases to be taken up in 
their proper places. 

REMEDIES FOR INFLAMMATION. 

The remedies which operate against inflammation, are call- 
ed antiphlogistic, and are composed of medicines and regimen. 
We shall consider in the first place, the regimen which it is 
proper for a person to use while afflicted with this disease. 

The first act of judgment in the treatment of a person labor- 
ing under inflammation, relates to a proper regimen, and the 
removal of all present causes of the disease. If it has been 
brought on by exposure to the action of any caustic, or poison- 
ous substances, or the presence of a foreign body, acting on 
or injuring the parts affected, these causes should be removed 
without delay. The next thing is to adopt a regimen suited 
to the case. As a general rule, this regimen will consist in 



INFLAMMATION. 193 

the use of the lighest food ; a total abstinence from every ar- 
tificial stimulant, the use of cold water only as drink, and a free 
exposure to cool or cold air. These measures are the more 
necessary, where the disease is sudden and violent, and where 
the parts affected, are essential to life, or its enjoyments. If 
for instance, the brain, the lungs, or even the eye, are affected 
with acute inflammation, total abstinence for a time, will be 
necessary, and this is but a small part of the antiphlogistic 
measures, which will be required. But where inflammation 
is of long continuance, the regimen must, in some degree, con- 
form to the requirements of nature. Food and drink must be 
allowed, but under such regulations, as the nature of the case 
requires. In these cases, the food chosen should be nutritious, 
but not stimulating, and used only in the quantity necessary 
to sustain the patient. In many cases of deep seated inflam- 
mation, a rigid adherence to a low regimen, has accomplished 
wonders. This is especially true, where dropsical swellings 
attend them. But there are other diseases, in which symp- 
toms obviously inflammatory, are not relieved, but made 
worse, by an abstemious course. This is true in scurvy and in 
scrofula, and, I will add, in many cases of rheumatism. The 
treatment of these inflammations, can only be successful, un- 
der a careful attention to the progress of the disease, under a 
regimen varied, from time to time, to suit the present circum- 
stances. In many cases, a diet generous and nutritious, is 
the best. 

The remedies which are required, for the removal of the 
acute inflammation of important organs, are of the most pow- 
erful and efficient character. By far the most important of 
these, is bloodletting. This remedy has maintained its ground 
from the earliest agec>, and under every change in theory or 
doctrine. It is employed in various ways — by leeching, cup- 
ping, or scarification, or by opening a vein or artery with a 
lancet. As a general rule, the best course is to open a vein in 
the arm, and to abstract the requisite quantity of blood by a 
full stream. A great deal has been said of the necessity of 
continuing the discharge, till the pulse is sufficiently reduced, 
and no longer. This rule, I think, is seldom available for an} 7 
good purpose in practice. Many persons become faint, the 
instant the blood begins to flow, and the pulse suddenly gives 
way before a sufficient quantity has been drawn ; others sus- 
tain this operation in a manner quite as extraordinary, and would 
by the same rule, require the abstraction of a quantity of blood 
too great for the necessity of the case. The best method is, to 
13 



194 INFLAMMATION. 

make up your opinion as to the quantity of blood which should 
be drawn, and to draw it in a vessel in which you can judge 
property when your object is accomplished. 

If your patient is liable to become faint under the operation, 
let him be placed in a recumbent posture while it is perform- 
ed. How far this powerful remed\ T should be carried, has 
been a matter of dispute for a great length of time. It was 
long thought, that the operation should be repeated, from time 
to time, till the pulse was brought down to something like a 
healthy standard. This is to some extent, the object of the 
practitioner of the present day ; but if he is well informed, he 
will be apprised, that this is not alwa} 7 s practicable. There 
are diseases, in which the pulse refuses to give way to the lan- 
cet, and others in which, at first, it gives way too easily, but is 
followed by a reaction, in which it is more strong and bound- 
ing than before. In such cases, the attempt to reduce the pulse 
by continuing the abstraction of blood, would be certainly fa- 
tal. A sound discretion must be used, in deciding how far 
the bloodletting is to be continued. The practitioner should 
never forget, that this is not his only remedy, and that it will 
be prudent to leave something for other means to accomplish. 
In cases of chronic inflammation, the proper use of the lancet, 
is attended with still more difficulty. In these cases, the use 
of this remedy, would seem to be forbidden by the debility of 
the patient, and the apparent sufficiency of other and milder 
measures, to accomplish all the purposes intended. But, in 
many cases, there is a hardness and resistance of the pulse, 
which is seldom equalled in other disorders. This state of the 
pulse, I have found to resist, other remedies, in a wonderful 
degree. Small bleedings frequently repeated, have accom- 
plished more, in my hands, under these circumsiances, than all 
other remedies united. It matters not how pale and emacia- 
ted the patient may be ; if his pulse is of the kind I have de- 
scribed, he will bear the lancet longer, and more beneficially, 
than any remed} 7 whatever. It is thought that the abstraction 
of blood from the inflamed vessels, or from those of the part 
affected, has much more power in relieving inflammation, than 
when the blood is drawn from a vessel in a distant part of the 
body. This idea has given rise to cupping, leeching, and other 
modes of local bloodletting. These remedies are unquestiona- 
bly of great benefit in many cases ; they are as well establish- 
ed, as any of our means of combatting this disease. They are 
called for when the disease is superficial and local, and in 
some cases, where the strength of the patient is deemed insuf- 



INFLAMMATION. 195 

ficient to sustain him under general bloodletting. It would ex- 
tend this article too far, to point out the various circumstances 
under which these modes of abstracting blood, should be pre- 
ferred. The extent to which bloodletting should be carried, 
in the treatment of any case of inflammation, is a matter to be 
well considered. The obvious debility, and even danger to 
life, from the loss of too much blood, should be constantly borne 
in mind. The appearance of the blood when drawn, is a guide 
of some value in these cases. If the blood is of a fiery red 
color, flows with a strong stream, and, after standing to grow 
cold, is formed into a hard clot, covered on the top with a lay- 
er of tough buff-colored jelly, or lymph as it is called, the ab- 
straction of blood has been proper, and may, if the symptoms 
do not yield, be repeated. If, on allowing it to stand for seve- 
ral hours, the clot contracts, separating itself from the vessel, 
and drawing up its own edges like a saucer, the proof of the 
high inflammatory character of the disease, is the more conclu- 
sive. But if on the contrary, the blood flows in a weak stream, 
is dark in color, and coagulates with a weak, or easily broken 
dark colored clot, the degree of inflammation is small. Be- 
tween these states of the blood, there are varieties which ren- 
der the judgment more difficult. I think the safest side to err, 
is in avoiding to repeat bloodletting in doubtful cases. 

Purgatives, are considered powerful remedies for the remo- 
val of inflammation. They are proper where there is much 
fulness of the blood vessels, and a torpid or inactive state of 
the bowels. They are used more freely where the patient is 
robust, and can bear depletion without injury. A very active 
cathartic for the reduction of inflammation, is composed of 
cream of tartar and jalap. Twenty grains of jalap, and a 
drachm of cream of tartar mixed together, and taken in water, 
is a common dose, and may be repeated according to circum- 
stances. Epsom salts, senna and salts, Seidlitz powders, and 
other similar cathartics, are considered particularly suited to 
this purpose. These are powerful remedies for the removal 
of inflammation, but they are not to be used in every instance. 
When the intestines are the seat of inflammation, cathartics 
are with a few exceptions improper. But there are other ca- 
ses, in which cathartics do not seem to benefit inflammatory 
diseases. In inflammation of the lungs, cathartics are always 
doubtful, and frequently improper. But with this and some 
other exceptions, they are used with great advantage in in- 
flammatory diseases. In chronic inflammation, there should 
be constant attention paid to the state of the bowels, and cos- 



196 INFLAMMATION. 

tiveness prevented by the use of such gentle laxatives as may 
he thought advisable. But these general rules cannot be fol- 
lowed safely without some knowledge of the nature of the dis- 
ease. The inflammation produced by rheumatism, differs as 
widely from that arising from pleurisy, as two diseases can 
well do ; and the remedies proper in each, are to be suited to 
the case. 

Mercury is a remedy of peculiar powers in cases of inflam- 
mation. It is not a mere cathartic, but exerts powers far grea- 
ter than we should infer from its visible effects. It is to be 
given with the knowledge derived from experience, of its bene- 
ficial effect in particular cases. In the treatment of dysente- 
ry, we are certain that we have no other remedy of equal 
value ; this is equally true in certain disorders of the eyes, 
and, in inflammation produced by syphilis, we can scarcely be 
said to have any other remedy. The best preparation of mer- 
cury is calomel, and it is to be given alone or combined with 
other remedies. It maybe used as a cathartic, or as a mere al- 
terative, according to the nature of the case in which it is 
administered. 

Opium is also a remedy for inflammation. This may ap- 
pear strange, when the great stimulating power of opium is 
adverted to. But this medicine is not a mere stimulant ; it is 
also a powerful sudorific and anodyne. These properties 
give it a. place in the treatment of many cases of inflamma- 
tion, in which the pain and irritation are leading symptoms. 
This remedy is seldom used alone, but where active remedies 
have been given, and the patient, although he is much exhaust- 
ed, is yet suffering from pain, a full dose of laudanum or Do- 
vers' powder, will be found extremely beneficial. In combina- 
tion with calomel, it has been found an invaluable remedy in 
many inflammatory disorders. But used alone, opium has al- 
so been found a powerful remedy in the treatment of the most 
painful inflammatory disorders. This is especially the case, 
where the disease is seated in any part of the intestinal canal ; 
and the doses of this remedy, which may be given safely to 
persons suffering under these agonizing diseases, are to be in- 
creased in proportion to the intensity of the pain. In the treat- 
ment of violent inflammation, patients are often suddenly pros- 
trated, even to fainting, by the use of powerful remedies or by 
excessive pain. Under these circumstances, we have no reme- 
dy that deserves to be compared with opium. The dose should 
be large. 

Antimony has long been considered a powerful remedy in 



INFLAMMATION'. 1 97 

the treatment of inflammation. The preparation of this reme- 
dy, which is now in the highest repute, is tartar emetic. The 
control which this medicine has .over the circulation, is re- 
markable ; and its effect in reducing the most dangerous forms 
of acute inflammation, equally decided. It has been adminis- 
tered in these cases as an active emetic, and there are some 
who still administer it in this way, especially in diseases of the 
lungs and trachea. But a different mode of administering this 
remedy, has of late prevailed, "From the well known effects 
of continued nausea in depressing the heart's action, nausea- 
ting doses of tartar emetic are frequently administered in in- 
flammation, in conjunction with other antiphlogistic measures. 
For this purpose, a quarter of a grain of tartar emetic may be 
given in solution every two or three hours. The first two or 
three doses generally produce vomiting, but afterwards con- 
stant sickness, is the only effect observed." In my own prac- 
tice, I am in the habit of combining nitrate of potash with the 
tartar emetic, and forming the antimonial mixture which I ad- 
minister in the same way. I think it a much more powerful 
remedy than the tartar emetic used alone. The doses of this 
powerful remedy are to be regulated by the endurance of the 
patient. As a general rule, it is desirable that nausea should 
be produced with little or no vomiting. The doses which will 
accomplish this, differ widely in different diseases, and in dif- 
ferent individuals. It is said that after vomiting has been pro- 
duced by it, the stomach will bear a gradual increase of the 
dose to a very large amount. This I have found to be the 
case in certain inflammations of the lungs, and in croup; but 
I have never pushed the remedy to the extent I have seen it 
recommended by others. I have seldom given more than half 
a grain of tartar emetic hourly, and even this dose will not of- 
ten be tolerated except in cases of croup. The addition of 
nitre gives to the remedy a decided increase of power, and 
does away the necessity of the gradual increase of the dose 
which has been so much recommended in the treatment of 
these diseases. The great benefit which is derived from the 
use of tartar emetic in the treatment of inflammation, seems 
to depend on the control it exerts over the pulse. This con- 
trol seems to be independent of any depletion or exhaustion of 
the fluids of the patient. The good effect of the remedy is 
obtained, and the patient after it is withdrawn, is left in the 
possession of sufficient strength to bear its use again and again. 
The local treatment of inflammation, ought not to be entire- 
ly omitted here. Besides the use of cups and leeches for the 



198 INFLAMMATORY FEVER. 

abstraction of blood, there are many remedies which are de- 
cidedly useful when applied to the inflamed part, or in its im- 
mediate neighborhood. The most important of these is cold, 
used in the form of cold water or ice, powdered and secured in 
bladders on the part affected. The inflammation of the brain 
or other organs contained within the cavity of the skull, al- 
though deep seated, is beneficially treated by the application 
of cold water to the head. Pounded ice, secured in bladders 
and applied in the same way, is a more powerful and useful 
remedy. The same beneficial result, may be expected from 
the application of cold to inflamed parts generally. Where 
the inflammation has arisen from violence, such as luxations, 
w r ounds, and other accidents, the greatest benefit may be ex- 
pected from the judicious application of cold. The same ef- 
fect is produced by the application of spirits, ether, and other 
volatile fluids. The rapidity with which they evaporate, 
carries off the heat very suddenly, and produces all the bene- 
ficial effects of cold. Where the surface is broken, or tender 
organs, such as the eyes, are implicated, these applications 
produce great irritation and cannot be used. 

But there are cases of inflammation, in which the applica- 
tion of cold, and other depleting local remedies, is improper. 
These cases, although attended with heat, swelling, redness, 
and pain, seem to depend on debility of the parts, and an in- 
terrupted circulation of blood in the veins. Erysipelas, scur- 
vy, rheumatism, and several other diseases, furnish examples 
of this. Several deep seated organs, the womb and intestines 
especially, are often affected with inflammation and pain of 
the same kind. In all these cases, cold applications are ex- 
ceedingly uncomfortable and pernicious ; and the tenderness 
of the parts affected is so great, that the use of leeches or cup- 
ping cannot be endured. It is no easy matter to prescribe 
properly in these cases. As a general rule, warm fomenta- 
tions, and w T arm poultices afford the greatest relief. But these 
important diseases, will claim from us more particular con- 
sideration under their appropriate titles. 



INFLAMMATORY FEVER. 

I am in great doubt, whether I have taken the best course, 
in giving the above title to a class of diseases. Mature, it is 
true, has marked in strong characters* the fevers which attend 



INFLAMMATORY FEVER. 199 

the high state of inflammation, which is often met with, in prac- 
tice. The fever which attends inflammation of the lungs, in- 
flammation of the brain, or inflammation of other parts when 
brought on by serious local injur} 7 , is, in its character, so mark- 
ed and peculiar, as to deserve to be set off' and distinguished 
from all others. Yet these diseases are so influenced by the 
parts they affect, and derive so many of their characteristic 
symptoms from the injuries done to these organs, that they are 
generally known by the organs they affect, more than by the 
character of the fever they give rise to. This " local habita- 
tion and name," which have by common consent, been assigned 
to these diseases ; make it convenient to arrange other dis- 
eases of these organs in the same class. The diseases of the 
brain, for instance, cannot well be distributed in various parts 
of a book on diseases. Those of the intestines, and those of 
the lungs, have equal claims to be considered separately ; and 
yet, all these may in their turn be the seat of inflammation, and 
the root and cause of inflammatory fever. It has therefore ap- 
peared to me best, to arrange these diseases according to their 
localities, and to give to inflammatory fever a very brief con- 
sideration in this place. 

Medical writers have called all fevers with great heat and 
full pulse, inflammatory, whether they have arisen from the 
malaria of marshes or the typhous affection of jails and crowd- 
ed ships. They have the best authority for using this term in 
this sense, and I shall not deny that they are right in so doiug. 
Still I think it would be better, to confine the term inflamma- 
tory fever to the diseases attended with local inflammation. 
Such is the course I shall take, and without desiring to urge it 
on others, desire onty, that I may be understood. 

Inflammatory fever produces or arises from inflammation of 
some part of the body, and tends to the disorganization, or de- 
struction of the part so inflamed. In its highest degree, it pro- 
duces murtification, or death of the part affected ; in its next, 
it produces suppuration ; and lower degrees produce more 
gradual, but often not less dangerous disorganization. Great 
examples of inflammatory fever, attend inflammation of the 
brain or lungs ; but the local causes which may give rise to a 
fever of similar grade, are without number. But there is a 
chronic, as well as an acute inflammatory fever, and what is 
more remarkable, the same disease produces sometimes one, 
and at other times, the other. Rheumatism, for example, pro- 
duces the acute as well as the chronic inflammatory fever. 

The symptoms of acute inflammatory fever, vary with the 



*• 



:200 INFLAMMATORY FEVER. 

organs affected. Violent and lancinating, or as it is sometimes 
called, stabbing pain in the organs affected, is the surest symp- 
tom. The fever which attends it, produces great heat, with a 
full, bounding pulse, restlessness and muscular pains in various 
parts of the body. These S3 T mptoms tend rapidly to the dis- 
organization of parts, and the destruction of life. The fevers 
which attend chronic inflammation, are attended with a great- 
er variety of symptoms. They are, however, very like the 
acute state of disease 1 have described, except that they are 
less violent. The state of the blood has still a closer resem- 
blance in these varieties of fever. When it is drawn from a 
vein in a full stream in a vessel of moderate depth, the surface, 
on cooling, is covered with a yellowish pellicle, which has been 
termed the buff coat. This is equally present in the acute and 
chronic forms of this fever. The blood, however, in cases of 
long standing, becomes water} 7 , and presents a small propor- 
tion of the solid parts of which it is usually composed. 

I shall not attempt to make a separate list of the fevers, I con- 
sider inflammatory. Such a list would soon be embarrassed 
with doubtful examples. As a general rule, the fevers which 
depend on any local cause are inflammator}'. But there are 
exceptions to this, as we shall see as we progress with the sub- 
ject. There are other cases in which fever continues after 
the disorganization of parts has taken place, and a profuse 
discharge of matter has occurred. These fevers are termed 
hectic, and are the reverse of those called inflammatory. 

The treatment of inflammatory fever, when met with in its 
acute form, is very much the same, whatever remote cause 
ma} 7 have produced it. The few exceptions to this rule which 
it may be necessaiy to make, will be carefully pointed out. 
The fear of the disorganization of important parts, and the con- 
sequent destruction of life, demands the use of the most effi- 
cient and powerful remedies. By far the most important of 
these is bloodletting. It is to be used according to the emer- 
gency of the case, and to be repeated, from time to time, as 
long as the symptoms demand it. A sound discretion is to be 
used in regard to the extent to which this remedy is to be car- 
ried. The practitioner should never forget, that the blood 
withdrawn from his patient, can never be restored, and that 
there are besides bloodletting other important remedies for 
the arrest of inflammation. The young practitioner should 
be informed, that almost every physician, who has grown old 
in the profession, has used the lancet less frequently, as expe- 
rience has taught him the sure reliance he may place on other 






DISEASES OF THE BRAIN. 201 

remedies. JNext to the lancet, we may place cathartics. These, 
it is true, are not applicable to every case; but they are a pow- 
erful means of depletion, and when carried to a great extent, 
but little inferior to the lancet itself. They are to be used 
with equal care, that they are not carried to a dangerous ex- 
tent. Emetics, especially tartarised antimony, form also a 
powerful means of arresting inflammation. The antimonial 
mixture, in which nitre is combined with the tartar emetic, is, 
in my opinion, the best remedy we have for ordinary attacks of 
inflammatory fever. It may be administered as a full emetic, 
or in nauseating or broken doses, according to the requirements 
of the case. These are the most powerful general remedies 
for inflammatory fever ; but there are local remedies which are, 
in many instances; scarcely less important, than those we have 
mentioned. Where the seat of the inflammation is well defin- 
ed, the application of leeches, or the withdrawal of blood by 
cupping, as near the parts affected as practicable, have been 
found very important. The application of cold by means of 
cold water or ice, it often more manageable, and often more 
efficacious ; few remedies in our possession are of more gene- 
ral utility. I shall not enter into the consideration of the pe- 
culiar treatment of chronic inflammation. Its remedies are 
much the same with those used in the acute form of this dis- 
ease, and require only to be regulated according to its degree. 
But there are many cases in which from the remote cause of 
the disease, particular remedies have been found useful. Mer- 
cury and iodyne are the most powerful of these alterative 
remedies. These, and other medicines which have been 
found useful in the treatment of chronic inflammation, will be 
pointed out in their proper place. 



DISEASES OF THE BRAIN. 

The most interesting of the diseases which affect the human 
body, are those of the brain ; for they involve not only health 
and life, but the mind, which is far more important than either. 
The brain, both in its structure and functions, differs altogether 
from other parts of the body. We can form no opinion of its 
uses from its appearance ; and are still profoundly ignorant of 
the mode in which its functions are performed. It is agreed 
on all hands, that the brain is the organ of the understanding ; 
and that all our senses, and all our rational powers, are brought 



202 INFLAMMATION OF THE DURAMATER. 

into activity and use in this organ. Some knowledge of the 
particular powers of certain parts of the brain, may have been 
obtained through the labors of the phrenologist ; but the knowl- 
edge so obtained has not yet been made very valuable in medi- 
cal investigations. 

The brain, placed in a closed bony case, extends beyond the 
cavity of the scall, down through its own channel in the spine. 
Considerable change takes place in the function it performs, 
after leaving the scull ; and something is known of its pecu- 
liar functions ; but even this has not availed us much, in treat- 
ing diseases of the brain and the nervous system. Our knowl- 
edge of the whole subject must be acknowledged to be imper- 
fect ; and yet it is still of some importance, and very worthy 
of attention. 






INFLAMMATION OF THE DURAMATER. 

By this name we know the investing membrane of the brain ; 
and, as its diseases are often the result of accidents, which in- 
jure the scull and expose this membrane to view, we have 
better opportunities of investigating them, than where the dis- 
ease is seated in deeper organs. 

Inflammation of the duramater, is apt to rise and progress 
slowly ; even where the skull is fractured and this disease su- 
pervenes, the wound made in the skin is sometimes healed, be- 
fore the inflammation of the duramater makes its appearance. 
I once attended a man who received a blow on the head with 
a stick ; the wound made in the skin healed up in about a 
fortnight, and there was no symptom of injury to the brain. 
He returned to his common employments, but at the end of 
three weeks, a dull pain in the part manifested itself. I was 
called to see him the next day, and found him sitting so stupid 
as scarcely to recognize me. The scalp where the wound had 
been inflicted, was a little puffed, and a considerable fever had 
already supervened ; he sunk in three days under coma, trem- 
or of the muscles, and other symptoms of pressure on the 
brain. He died before a suppuration had taken place under 
the scalp, and no opportunity of a post mortem examination 
was allowed. This case is a common example of this particu- 
lar affection, of the investing membrane of the brain. The 
leading characteristics of the disorder are, a dull pain, with 
great heaviness, succeeded by coma, and too often by death. 



INFLAMMATION OF THE BRAIN. 203 

The remedies for this affection are by no means peculiar — 
they are those of inflammation in general. The treatment is 
to be begun by bloodletting, followed up with active cathartics 
and cold applications to the head, made by means of ice in 
bladders if it can be obtained, but if not, by cold water fre- 
quently applied by wetting napkins. A more efficient use of 
this remedy may be made, by shaving the head, and pouring 
water on it, by a very small stream from a foot or two in height. 
This is a most powerful remedy, and not to be persisted in, too 
long at one time ; but it is to be recollected, that the disease is 
one that admits of no medium remedies ; it is to be treated by 
those which are most powerful. 

It is to be regretted, that the first symptoms of this disease 
do not often bring the patient to his medical adviser for a reme- 
dy — the danger is not sufficiently manifest. When the phy- 
sician is consulted, the symptoms are sometimes too mild to 
excite his fears ; it is therefore important, that, in these cases, 
the alarm should be taken sufficiently early. There can be no 
doubt that a salivation, could it be brought on in due time, 
would do more to arrest the progress of this inflammation, than 
any other remedy. Calomel should be given with the cathar- 
tic remedies already recommended, and it should be continued 
in such a manner as to produce a salivation, should the case 
continue long enough to admit of it. If the symptoms of the 
approach of this disorder become manifest before fever has 
supervened, the attempt to produce a salivation should be in- 
stantly instituted, by giving five grains of calomel once in six 
hours. 



INFLAMMATION OF THE BRAIN— PHRENITIS. 

The brain is sometimes involved in general inflammation, 
though it has been disputed whether the proper substance of 
the brain, or its membranes and vessels, were the organs af- 
fected. The symptoms which attend this disorder, are such 
as are produced by pressure; but there are not wanting instan- 
ces where similar symptoms are brought on, by the very re- 
verse of this. Owing to its situation in the skull, the brain ob- 
viously admits of no enlargement by swelling; when there- 
fore its vessels or membranes become inflamed, a violent pres- 
sure of the soft substance of the brain is a necessary conse- 
quence ; its functions are deranged, the patient can respond to 
no question, and hence a very great difficulty in investigating 



204 INFLAMMATION OF THE BRAIN. 

it. When from exhaustion of the fluids by lessening the quan- 
tity of blood, the brain ceases to receive a sufficient supply of 
this fluid, the mind also ceases to act, and fainting or stupor 
takes place; this has been called a collapse. 

The causes of inflammation of the brain, are those which 
excite ordinary inflammatory diseases, such as cold, injuries 
&c; but there are other causes peculiar to this organ ; these 
operate on the senses or on the intellectual faculties. Expo- 
sure to violent heat, and the glaring light of the sun, has pro- 
duced this disease sometimes with great suddenness ; many 
have died, in this way, from what has borne the name of a 
stroke of the sun. Intense thought alone has, in some cases, 
been found sufficient to produce this awful disease ; great ap- 
plication to business, especially when the excitement of failing 
circumstances is added to it, has sometimes been found a suffi- 
cient cause. 

I have seen no mention of this disease as an epidemic, by 
any author ; but I have certainty seen it prevail, from some 
general unknown cause, more than once. About as early as 
my memory of such a fact can be relied on, it prevailed in the 
neighborhood in which I lived, and destroyed several persons. 
The disease bore in the neighborhood the name of head pleu- 
risy ; and, in some of the cases, terminated fatally in about 
four days. 

Since I became a practitioner of medicine, I have once seen 
this disease prevail in a similar way ; there were not a great 
many cases, but I recollect being called to attend two which 
proved fatal ; and there were several other fatal cases which I 
did not see. Now, in these instances I recollect no collateral 
disease or other circumstances, which could account for the 
occurrence of several cases of rare disease, like this, so near 
the same time. I conclude that there must have been some un- 
known cause, in the general state of the atmosphere. 

The first symptom of this disease, is commonly a deep, in- 
tense pain in the head ; the eyes are watery, and more or less 
red, the pulse full and bounding, the skin hot, and the tongue 
white. The disease, thus far, might not be known for inflam- 
mation of the brain ; but soon a graver set of symptoms pre- 
sent themselves. A violent convulsion happening under such 
circumstances, is thought to be the most infallible sign of the 
presence of inflammation of the brain. A furious delirium 
comes on where convulsion does not; and coma, the certain, 
final result of delirium or convulsion, takes place. In this 
state, the patient writhes in agony, moving his limbs in all di- 



INFLAMMATION OF THE BRAIN. 205 

rections, and breathing with a deep snoring sound. As the 
disorder progresses, the breathing becomes deeper and more 
convulsive, till, at last, the froth is thrown from the mouth, with 
an exhibition of agony scarcely equalled in any other disease. 

These symptoms do not always occur in the order in which 
they are here set down , nor are they, by any means, all the 
symptoms which may be expected. In some instances, nau- 
sea and vomiting with the discharge of a large quantity of bile 
prevail ; and throughout the whole course of the disease, cos- 
tiveness is almost always present. In some instances, the 
mind seems, at an early stage, to sink into a sort of lethargy, 
with strabismus or cross eyes; in others, the pupils of the eyes 
are so contracted as to be almost obliterated. 

Inflammation of the brain is an acute disease, sometimes 
running its whole course in two days, or less ; but, in other in- 
stances, it has lasted for two or three weeks. But where ca- 
ses terminate fatally, they finally bring on the characteristic 
coma, with twitching of the muscles, great agitation and too 
often death. 

TREATMENT. 

Bloodletting, purging and the application of cold, form the 
principal remedies for inflammation of the brain ; they are to 
be used with a full sense of the violence and danger of the 
disorder, and with a knowledge, that if it is not arrested, life 
can hardly be expected to continue many days. 

Bloodletting is to be resorted to, as soon as the nature of the 
disease is ascertained ; and, although the symptoms may not 
be very violent, the quantity of blood taken should be consid- 
erable — two pounds are not an immoderate bleeding in such 
a case. The remedy is not to be lost sight of with the first use 
of it ; but to be resorted to again in a few hours, or from day 
to day, as the emergency of these symptoms, and the strength 
of the patient may seem to demand. When blood has been 
freely drawn from the arm, and the symptoms do not yield, 
cupping on the temples, or leeches, may be beneficially used. 
It is not to be expected that the pulse will yield, in this dis- 
ease, to the lancet, as readily as it does in others ; I have found 
it, on the contrary, to resist the impression, and to remain full 
and bounding, even when the quantity of blood I thought it 
safe to take, had been drawn. The violence of the symp- 
toms will, however, lessen with the flow of blood. 

Cathartics are plainly indicated in this disease, and are 
justly held in the highest estimation. They do not operate 



206 INFLAMMATION OF THE BRAIN. 

readily, and this forms the greatest objection to them. Croton 
oil is thought to be the best cathartic in these cases. From 
four to eight drops may be given every three hours, till it 
proves cathartic. I should give, with equal confidence, cream 
of tartar and jalap. Take a drachm of jalap, and half an 
ounce of cream of tartar ; rub together and make into four 
powders ; give one of these every three hours, till they ope- 
rate as a cathartic. If four of these powders fail to operate, 
take half an ounce of senna, pour on it a pint of boiling water, 
and, when well drawn, strain offj and add two ounces of Ep- 
som salts, give a wine glass full of this, hourly, till it operates. 
Having procured a free evacuation of the bowels by these ac- 
tive cathartics, give calomel in doses of five grains, four or five 
times a day, till the result of the case is decided, or till a sali- 
vation is brought on. 

Cold applications to the head, are a leading and decidedly 
beneficial remedy ; they are best made by pounded ice, pat 
into bladders, and kept nearly all the time applied. It is only 
necessa^ to remark, that a material so cold should not be 
kept too great a length of time on the same spot, on one who 
is wholly insensible. It should be removed, but not in such 
a manner as to allow any part of the head to become obviously 
warm. Where ice is not at hand, cold water applied by 
means of towels, may be substituted. The douch of the Cold 
Water Doctors, may find, in such cases, a place for its bene- 
ficial application. I should, by no means, advise their system 
of throwing a heavy column of water, from a great height on 
the patient ; but use a small stream from a pitcher, held a foot 
or two above the head. It is a powerful remedy, and should 
not be continued too long at one time. 

By these powerful means, the patient is, in some instances, 
brought down to a very low point ; in other instances, very 
rare I suppose, what has been termed a collapse takes place, 
and the patient is found suddenly pale and cold, with pulse 
scarcely perceptible, and in a state more resembling fainting 
than any thing else. The crisis is now at hand, and counter 
irritants may be beneficially used ; blisters, or mustard which 
is more prompt in its action, may be applied to the extreme- 
ties. If, on the application of mustard, the pulse does not, in 
a short time, rise, thirty drops of laudanum may be given. 
By such means, some have been snatched, as it were, from the 
grasp of death, but such examples are rare. 

If by these means, the symptoms give way, and the patient 
is restored to a state of convalescence ; every means should be 



DELIRIUM TREMENS. 207 

used to avoid a relapse ; the most perfect quiet should be ob- 
served for days, or even weeks ; the diet should be of the low- 
est or least stimulating kind ; and no exposure to unnecessary 
heat or intense light, should be allowed ; and if, under all these 
precautions, the disease should return, the same routine of 
treatment should again be adopted ; but with less activity, as 
the weakened strength of the patient will obviously require, 
and, it must be added, with less hope of success. 



DELIRIUM TREMENS. 

This disease arises, in almost every instance, from the ex- 
cessive use of alcohol, in some of its forms. The drinker of 
brandy is the most subject to it ; but wine, and even porter, 
has been known to produce it. It is not the result of a single 
debauch ; but is the evidence of a constitution exhausted by 
a long continuance of habits of sottishness. 

The first symptom of the approach of this disease is sleep- 
less nights; the patient becomes impatient and restless, rising 
from bed long before day, and setting out in quest of his daily 
potation. If he retains his drink, and, by a little prudence, 
takes less than he had taken the day before, he will proba- 
bly be rather better than worse, the next night. But the 
stomach is not commonly indulged in this way, with any alle- 
viation of its labors, but is called on, from day to day, to re- 
ceive larger and larger doses, till at last it rejects them alto- 
gether. The unfortunate man feels the approach of this pe- 
culiar insanity, and with great fear, and sometimes, appar- 
ently with the greatest degree of reluctance, forces himself 
to repeat the draught to ascertain if it will slick; for as soon 
as he has retained a single draught, he feels himself safe 
for the day. It matters little how many days he shall be 
able thus to begin his career of drunkenness ; his stomach 
cannot endure forever, and the day arrives that he must face 
the horrors of the peculiar disorder which has acquired the 
name of delirium tremens, or delirium with trembling i and 
truly is he represented trembling and delirious. 

The mind seems now more affected than the body ; the agi- 
tation of the sufferer can hardly be conceived ; his fear is in- 
tolerable, and when nothing assails him, he is still expecting 
evils in every shape. He distrusts whatever is said to him, 
and is commonly as regardless of truth, as he supposes others 



208 DELIRIUM TREMENS. 

to be. No matter what his original integrity, you can believe 
nothing he tells you in reference to his disease. 

Nothing can be more grotesque than the fears which arise 
in the minds of men under these circumstances; sometimes 
their apprehension will suggest the approach of individuals to 
assail, injure or destroy them; but quite as commonly, they 
think themselves assailed by rats, or something still more 
harmless. I have seen a man under these circumstances, 
who supposed himself covered with vermin, and commenced 
throwing his clothes into the fire, and was with the greatest 
difficulty restrained from throwing in also his bed and bed 
clothing. As the disease grows worse, there is great danger 
that the patient will commit suicide; but towards others, he is 
commonly harmless, and indeed cowardly. It is seldom that 
the first attack of this disease proves fatal; and quite as rare 
for the inebriate who has brought himself to such extremity, 
to reform — he will abstain for a time, under many promises, 
which are too apt to be broken. 

This disease has been thought to bear a close resemblance 
to inflammation of the brain ; indeed it is thought to be fre- 
quently productive of more or less inflammation of that organ. 
To me it appears much more to resemble madness; and, in 
many instances, the delirium, if it is delirium, bears every 
analogy to monomania. There can be no doubt, that, in ex- 
treme cases, the brain becomes seriously disordered ; but I must 
think that a true inflammation rarely arises in the brain of one 
whose sensibilities have been exhausted, to the last degree, 
by intoxication. It is true, that in this stage of the disease, 
violent convulsions are frequently brought on, and the patient 
runs into a deep state of coma; but, even here, I would sooner 
think that the coma was rather a result of collapse, and pros- 
tration, than of inflammation. 

Writers have stated that this disease is sometimes of a 
mixed character, presenting a true state of inflammation of the 
brain, with delirium tremens; but I must think such cases 
exceedingly rare. 

TREATMENT. 

Several modes of treating this disorder have been proposed, 
and each has, perhaps even now, its advocates. Some give 
emetics, others alcohol, others forbid all remedies, and advise 
rest, quiet, and darkness. But the best authorities concur in 
the use of opium, as almost the sole remedy in delirium tre- 
mens. This has been, for many years, my practice ; and I 



DELIRIUM TREMENS. 209 

have had every reason to be satisfied with it. The disease 
seems to be brought on by an inability to sleep, and by the 
use of opium we procure this great requisite of nature — we 
produce sleep. The patient should be given two grains of 
opium at once, with a direction to take one additional grain, 
every three hours, till he drops to sleep. Laudanum may be 
substituted for opium, without any inconvenience; from fort v 
to sixty drops may be administered at first, and followed with 
doses of twenty drops, till the same end is accomplished. — 
When I have been called to an individual who had just had a 
violent convulsion, I have administered a tea spoonful of lauda- 
num, as soon as the patient could be gotten to take it; and, in 
the event of being unable to procure its administration other- 
wise, I have directed three tea spoonsful, in a gill of water, 
thrown up as an injection. I have had the greatest reason to 
believe that this remedy was exceedingly useful. Now, if 
there are cases in which there is present an inflammation of 
the brain, which would forbid the use of opium, the cases at- 
tended with convulsion would seem to be of that sort. It is 
true, such persons often fail to recover from the coma, and die, 
leaving on the minds of some a suspicion, that the laudanum 
which may have been used, was instrumental in producing 
the death; still I have no hesitation in preferring this remedy 
in this case. If the patient will die under the use of lauda- 
num, he will unquestionably die without it. 

Very little variation in the practice is necessary, in different 
cases of this disease. The only variation which it is impor- 
tant to recollect, arises from the fact, that the patient has been 
long accustomed to his daily potion of alcohol, and that, at 
first, it may be dangerous to attempt to withhold it altogether 
from him. I have, in numerous cases, on finding my patients 
resist the force of laudanum in such doses as I thought it safe 
to prescribe, given a portion of brandy with the happiest re- 
sults. In such cases I have given about three ounces of strong 
spirits, with thirty drops of laudanum at a dose, and have 
found it succeed, after doses of three grains of opium had 
failed. 

Having once produced a quiet sleep, we consider the main 
point gained in the treatment of this disease ; if it is a first at- 
tack, probably nothing further will be required; but, in bad 
cases, it appears almost impossible for the patient to get along 
without some stimulant. The best, by far, would be alcohol, 
in daily diminished doses ; but this is almost certain to restore 
the habit which it is our greatest object to destroy. I there- 
14 



210 DROPSY OF THE BRAIN. 

fore advise every means which can be used to avoid all spirit- 
uous or fermented liquors. When the stomach is not so dis- 
ordered as to hinder the digestion of food, he should bead- 
vised the use of rich and highly spiced soups; and, with- 
out much delay, the use of the richest animal food. These 
are the safest and best stimulants, and are commonly suffici- 
ent. Where they prove insufficient, and are rejected from 
the stomach, I advise other stimulants. Camphor, combined 
with opium, may be used in these cases. Take an ounce of 
spirits of camphor, and add to it a tea spoonful of laudanum; 
give thirty drops of this, from time to time, so as not to ex- 
haust the whole in less than two or three days. Other conve- 
nient stimuli may be adopted in place of these; and, if the 
patient has a will to be well, he will not return again to his bev- 
erage of alcohol. But the great difficulty lies in giving to the 
will, power, and control in the matter. A man in this per- 
ishing condition has no will of his own. 



DROPSY OF THE BRAIN— HYDROCEPHALUS. 

This disease, although exceedingly dangerous, is not always 
incurable. That it may be cured, it should be known at an 
early period, for it. so»n progresses to a stage in which there is 
little hope of benefit from remedies. Its premonitory signs 
are therefore very important, although it must be confessed 
they are often surrounded with much doubt and difficulty. The 
disease attacks principally children, most frequently during the 
stage of dentition ; but sometimes a few years later. 1 have 
never met with it in a child more than six years of age. 

We are told that scrofula is the great pre-disposing cause of 
dropsy of the brain, and that the disease is frequently met with 
in scrofulous families, destroying several children in succes- 
sion. Happily there is a great portion of the earth not much 
subject to the prevalence of scrofulous disorders ; in the South- 
ern States, in which my observations have been made, scrofula 
is comparatively rare. 

Dropsy of the brain has never, within my observation, ap- 
peared to be a family disease ; I have never met with it even 
in two children of the same family. The chief cause of dropsy 
of the brain, where I have seen it, has seemed to be teething, 
or the diseases arising from it. In a few instances, I have wit- 
nessed it in children who had, several years, passed the age of 



DROPSY OF THE BRAIN. 211 

teething, and enjoyed a reasonable portion of health. In these, 
the disease had come on without any obvious cause. Besides 
these causes, it may be well to mention injuries of various 
kinds, such as falls, bruises, surgical operations, or any thing, 
indeed, which is calculated to produce inflammation of the 
brain. 

SYMPTOMS. 

Dropsy of the brain arises from inflammation of that organ, 
and is consequently characterized by the same symptoms. Its 
attack is sometimes sudden, but more frequently gradual. 
When its attack is sudden, which may be in the midst of fever, 
with disordered bowels, the onset is apt to be with convulsions. 
These convulsions are not characterized by any thing peculiar ; 
but the child, after they pass off will be found with its eyes 
fixed across, great tenderness, and inability to bear the light ; 
probably total loss of sense, clenched fists, with writhing of the 
body, and great agony. These symptoms, if the disease is not 
promptly arrested, go on increasing, and terminate fatally in a 
few days. 

But it is in the cases in which the onset of the disease is 
slow, that it is most important our investigations should be 
made with care and success. The patient is commonly al- 
ready in very reduced health ; in almost all the cases I have 
witnessed, great disorder of the bowels, the summer com- 
plaint of children, has already reduced them comparatively 
low. Writers inform us that a tenderness of the abdomen is 
commonly the first symptom ; I have not noticed this symp- 
tom, but have first observed the child with more fever, and a 
more frequent, rapid and bounding pulse, than its other symp- 
toms would render probable. If it has its senses, it will de- 
scribe a pain in its head ; if not, it will frequently start from 
its sleep, springing suddenly up with clenched fists, the thumb 
being commonly drawn violently down into the hand. These 
paroxysms pass off, and some degree of dulness is observable ; 
the child will soon desire to lie down, and this soon becomes 
the leading symptom. The child will struggle to escape from 
the arms of its mother to its bed, where it will seek to place its 
head as low as possible. Days frequently pass under these 
circumstances, the child not manifesting much disease, seem- 
ing to be only dull and inanimate, and claiming all the time its 
place in bed. To these symptoms, those of greater irritation 
begin to be added ; some stiffness is found in the neck, and 
tenderness over the scalp, which forbids the handling of the 



212 DROPSY OF THE BRAIN. 

head; nausea and vomiting succeed, and the eyes, on a close 
inspection, are found, one or both of them, more or less dis- 
torted. These symptoms constitute the first stage of the dis- 
ease, they are frequently met with successful remedies, and 
ought by all means, to be carefully watched, and referred to 
the ablest counsel. 

Great pains have been taken, in pointing out the various 
stages of this disease, and their proper symptoms. To me it 
seems sufficient to add, that the symptoms which characterize 
heavy pressure on the brain, by the effusion of water into its 
ventricles, constitute a last stage of dropsy which need not be 
divided. The vision of the patient seems first to give way, 
and the eyes become distorted, the understanding fails, and it 
responds to nothing said to it, or done for it. Its breathing be- 
comes heavy, and restlessness and agitation of its limbs, be- 
come conspicuous. The action of its bowels becomes invol- 
untary, and it has frequently, convulsions. Several weeks 
sometimes elapse before death — which should now be most 
welcome — closes the scene. 

TREATMENT. 

In the treatment of this terrible disease, great liberties have 
been taken with the powers of nature, and a great variety of 
opinions expressed in regard to the effect of remedies. While 
some have held that it was curable, in one out of three or four 
cases; and a few cases have been published of a rescue, from 
what would appear to be the last extremity of the disease, oth- 
ers have held that after the effusion of water into the ventricles 
of the brain, there remained not a shadow of hope; because 
there are no absorbents provided by nature for the taking up of 
such effusion. I have no doubt that the medium opinion is, in 
this, as in most other arguments, the safest, and nearest to 
truth. Like consumption, dropsy of the brain, when it has 
proceeded to a certain point, is incurable; but, at an earlier 
stage, I have no doubt remedies are often used with entire suc- 
cess. That success may attend the use of remedies, they 
should be used efficiently, and at an early stage ; and, al- 
though at this period, it is doubtful whether the symptoms jus- 
tify the belief that a watery effusion in the brain has taken place, 
We are sufficiently rewarded if relief is obtained, although the 
fact that it was really a dropsy of the brain may be contro- 
verted. 

In the first stage of the disease, while the pulse is rapid and 



DROPSY OF THE BRAIN. 213 

full, the patient's senses not destroyed, but great heat about the 
head, and other symptoms of fever, show the bad tendency of 
the disease, bloodletting, by means of leeches applied behind 
the ears, or at any point nearest the hairy scalp, will be proper. 
This prescription is suitable where the child is small, under 
two or three years of age, and where a small number of leech- 
es will be sufficient. Three or four will be enough to apply 
at one time; and if they are large, and blood flows freely from 
the bite of one, perhaps it may prove sufficient, without the 
application of others. I object to the copious abstraction of 
blood recommended by some, in these cases. It should be 
recollected, that bloodletting is not the only evacuant intended 
to be used ; and that patients are commonly a good deal re- 
duced before this remedy is called for, by the appearance of 
this disease. 

Cathartic medicines form the next, and I may say, greatest 
reliance of our patients, in this disease. Calomel and jalap has 
received the highest commendation of any remedy at this cri- 
sis; and 1 fully concur in the high opinion given of it. Take 
twenty grains of calomel and sixty of jalap ; rub together and 
divide into eight powders ; give one of these powders to a 
child two years old, every four hours, till they operate as a ca- 
thartic. A single one of these powders may be well consid- 
ered an active cathartic, for a child of so tender an age ; but 
the torpid state of the bowels, which so generally attends drop- 
sy of the brain, fully authorizes us to begin with the efficient 
doses recommended ; and should they prove insufficient, they 
may be doubled. This is far short of the amount of cathartic 
medicines which have been recommended, in this disease ; but 
a single cathartic will hardly end the treatment, of a case of 
this kind, and a remedy so active may not be safe to repeat 
every day. It is better, therefore, after twenty-four hours, to 
substitute some other cathartic ; and I should prefer senna and 
salts to any other ; this purgative should also be given in bro- 
ken doses, so that too much may not be given at once. 

The nausea and vomiting which sometimes attend this dis- 
ease, have been a source of great embarrassment in its treat- 
ment. Frequently every cathartic medicine is rejected al- 
most, as soon as swallowed ; in these cases, I have given, with 
great satisfaction, the antimonial mixture. Take of tartar 
emetic two grains, nitrate of potash two drachms, dissolve in 
eight ounces of water, and give a tea spoonful every half hour, 
till it operates as an emetic. This prescription is for a child 
two years old; and the dose is to be lessened or increased, as 



214 DROPSY OF THE BRAIN. 

the patient may be older or younger. And, although the pa- 
tient may, at the time, be throwing up even a mouth full of 
tea ; it will probably retain the antimonial mixture, till it has 
taken several doses, when it will operate as an ordinary eme- 
tic. After this, cathartic medicines may be administered with 
ease and success. This use of tartar emetic, for which I be- 
lieve I have no authority but my own experience, should not 
be persisted in, if it begins to operate as a cathartic ; but even 
in that case, 1 have found it to do more to quiet the stomach, in 
these cases, than any thing else. 

The application of cold to the head, will suggest itself as a 
matter of course. We are directing the treatment of an acute 
inflammation of the brain; not one, however, which threatens 
the formation of abscess, gangrene or other ordinarily fatal ter- 
minations of inflammation ; but a watery effusion, which is to 
be prevented by the suppression or putting down of the inflam- 
mation, before this effusion takes place. Cold applications, 
therefore, are as reasonable, as they have been proved to be ben- 
eficial. The best mode of making them, is by means of pound- 
ed ice, put in bladders, and laid on the head, which should 
be frequently turned from side to side, or the bladders remov- 
ed from one place to another, so that too intense a degree of 
cold may not be produced on any given point. In the absence 
of ice, linen cloths dipped in cold w^ater, may be applied. 
This remedy should be persisted in for several days, during 
the first stage of the disease. It may be dispensed with, when 
the heat of the patient no longer seems to require its use, or 
after the disease has subsided. 

We have mentioned the use of calomel, in combination with 
jalap, as a cathartic, in the first stage of the disease. Great 
faith is attached to it, in the later stages, when it is to be given 
in broken doses, so as to produce its peculiar constitutional 
effect, either in producing salivation, or deep green bilious pas- 
sages from the bowels. To this end, take of calomel six grains, 
cream of tariar thirty grains, divide it into eight powders. Give 
three or four of these powders, a day, in syrup. This may be 
continued, from day to day, as long as the symptoms seem to 
demand it. 

Blisters and diuretic remedies, especially squills, would 
seem to have a proper place in the treatment of this disease. I 
have no doubt they would be beneficial, and should be used in 
protracted cases ; but I have but little experience with them, 
because the cold applications which I have deemed it so im- 
portant to make lo the head, have excluded the one, and the 



DROPSY OP THE BRAIN. 



215 



constant use of cathartics which are considered still more im- 
portant, have hindered the use of the other. 

SPURIOUS DROPSY OF THE BRAIN. 

A great difficulty in treating the diseases of the brain, arises 
from the fact, that the most opposite conditions in which it can 
be placed, produce symptoms almost exactly alike. Violent 
pressure on the brain, produces coma, with total insensibility ; 
while the absence of the necessary healthful pressure to which 
the organ should be exposed, produces fainting, with the loss 
of sensibility, scarcely distinguishable from coma. The phy- 
sician should be always on his guard against mistaking one of 
these cases for the other, for their proper treatment is as oppo- 
site as their causes. The dropsy of the brain, of which we 
have been speaking, is attended with great pressure ; and we 
have given an account of the remedies which are proper for 
its removal; but sometimes children are attacked with the 
same languor and drowsiness which attend dropsy of the 
brain ; and, in some instances, it is said that frequent faintings 
with spasms or convulsions, take place ; but, in these cases, 
there is an absence of fever, and commonly the presence of 
collateral circumstances, which should place us on our guard 
against mistaking the nature of the case. If these symptoms 
happen immediately after a profuse discharge of blood, or af- 
ter the excessive or violent opperation of cathartic medicines, 
they may be well suspected of arising from the absence of due 
pressure on the brain from the circulating blood. If at the 
same time the extremities are cold, and the pulse feeble, and 
the symptoms are aggravated by attempting to support the 
child in an erect posture, we may be almost certain, that the 
disease arises from the cause under our present consideration — 
that it is indeed a spurious dropsy of the brain. 

The remedies for this state of things, especially when, it 
has occurred from any sudden cause, are obvious. The pa- 
tient should be supported by the use of powerful stimulants, 
and seasonable nutrition. If the patient appears to be in im- 
mediate danger of death, administer a dose of laudanum, four 
or five drops to a child two years old. Make a tea spoonful 
of strong brandy into toddy, and administer that as quickly as 
possible ; warm applications should be made to the extremi- 
ties, and, if the feet continue cold, let them be bathed in water 
containing a portion of mustard, or a strong tea of red pepper. 
If, under these means, the child revives, and recovers its sen- 



<z? 



216 DROPSY OF THE BRAIN. 

ses, some nourishment should be given it ; and, if it takes it 
with a reasonable appetite, there is strong reason for believing 
the case may be successfully treated. 

After the patient is, in some degree, revived, a system of a 
stimulating and supporting kind, is to be adopted. Sulphate 
of quinine may be beneficially used, for a day or two ; half a 
grain may be given to a child two years old, once in four hours. 
Preparations of iron may be substituted, or used after the qui- 
nine has been laid aside. Five drops of muriated tincture 
may be given in water, three times a da}^. Other preparations 
of iron may be tried — the precipitated carbonate is among the 
best — three grains of this may be given in syrup, three or four 
times in twenty-four hours. A generous and nourishing diet 
should accompany the use of these remedies. 

It is now believed that cases of this description, have hap- 
pened more frequently than medical men have supposed. It 
is obvious that the danger attending them will be increased by 
the use of bloodletting, and the active cathartics of which we 
have spoken ; while the stimulating and supporting plan we 
have recommended, give a very fair promise of success. Seve- 
ral authors have reported cases treated with entire success, by 
the stimulating plan of which we are speaking ; and I have no 
doubt that such cases would be fatal, under a different treat- 
ment. It is, therefore, exceedingly important, that physicians 
should be guarded in their prescriptions for these disorders of 
the brain. 

CHRONIC DROPSY OF THE BRAIN. 

The vitality and delicate structure of the brain, have taught 
us to regard the least invasion of it, with the greatest fear; but 
diseases sometimes prove our instructors in matters of this de- 
scription. The brain is susceptible of very great alteration in 
its position and dimensions, without the destruction of life. 
This happens in the disease under consideration, in a manner 
truly wonderful ; the head is sometimes enlarged by the pres- 
sure, or distending force of its dropsical contents, to two or 
three times its natural size. Great influence is sometimes ex- 
erted on the functions of the brain ; the mind is sometimes de- 
stroyed ; in other instances the senses are only deranged ; but 
in others, to the wonder and astonishment of every one, the 
functions of the mind remain, and are but little impaired. 

Chronic dropsy of the brain is an exceedingly slow disease, 
commencing, in some instances, before birth, but liable to hap- 



DROPSY OF THE BRAIN. 217 

pen at any stage oflife. It is not considered as an inflamma- 
tory disease, but may exist while the patient enjoys, to all ap- 
pearance, a tolerable degree of health, for an indefinite length 
of time. It has been known to have existed from childhood, 
in a man who lived to reach his thirtieth year. 

When dropsy of the brain makes its appearance in infancy, 
the head of the child takes on suddenly, an extraordinary 
growth and development ; the natural openings of the skull 
are enlarged ; and, in many instances, the bones are totally 
separated and may be felt, as it were, attached to the scalp — 
each one in its place, the whole head having a bladder-like 
softness. In the mean time, the bones of the face remain un- 
altered, and a strange angular appearance is given to the fea- 
tures ; the child ceases to be able to support its head, and is, 
in many instances, seen to do so by the aid of its hands. In 
this stage of the disease, many severe and awful symptoms 
take place ; convulsions are very common; paralysis of various 
parts of the body, blindness, deafness, and often death occur. 
But where life is not destroyed, the patient will be found to 
recover, in some degree, from the worst of these symptoms ; 
the bones of the head will grow, so that they will meet, and, 
by degrees, form a new bony case, of enlarged dimensions, 
and various degrees of deformity. In some instances, the 
union of bones is perfect, and the child recovers to a consid- 
erable degree of health, with its head so large, that it is whol- 
ly unable to hold it in an erect position. By degrees the mus- 
cles of the neck gain strength, and the little patient is seen, 
with great effort, to hold itself erect, and sometimes to walk, 
carrying its head with great labor, supported by its hands, as 
a child might do in carrying a heavy pail of water. 

The vivacity and health of some of these children, are truly 
surprising. I once attended one who recovered, and had a 
final consolidation of the bones of its skull, with its head near- 
ly twice the natural size. It was now about three years old, 
but unable to sit up, much less to walk ; yet it had perfect use 
of its hands and feet, and, apparently, a considerable acute- 
ness of understanding. It was the child of a poor man, and I 
felt interested in making the experiment of laying a piece of 
gingerbread eight or ten feet from it, to see how it would reach 
it. Its mode of travelling was by rolling, and its head, being 
so much larger than its body, made a progress much more ra- 
pid than its feet, which threw its line of motion on a circle. 
This however proved no impediment to the little fellow's 
reaching his bread ; for he would place his body on such a line, 



218 DROPSY OF THE BRAIN. 

that he knew the circle of his motion would reach the object of 
his pursuit, when he would throw himself into a rapid rolling 
motion, and reach his bread about as soon as aay crawling 
child could have done. This child acquired, by degrees, the 
power of raising its head, and emigrated, in apparent health, 
to a place so distant, that I have not since heard of it. 

Chronic dropsy of the brain, is not always a disease of chil- 
dren ; it sometimes happens even in old persons. The case of 
the celebrated Dean Swift, is known to literary men. He 
died of this disease at an advanced age ; having for many 
years experienced some disorder of the brain. The symp- 
toms by which it may be known in grown persons, are 
not very evident. The pressure on the brain which would 
arise from the accumulating fluid, would produce symp- 
toms easily recognised ; but the exact nature of the cause 
of that pressure, could not be readily ascertained. Yet, in 
the case of Swift, which has been alluded to, the character 
of the contents of his skull seemed to have been comprehend- 
ed ; for it is stated, that trepanning for the purpose of let- 
ting out the water, was suggested by one of his friends, but 
not adopted by his physicians. 

TREATMENT. 

It would seem to be nearly impossible to remove chronic dropsy 
of the brain. Indeed, I could hardly promise myself much suc- 
cessin the treatment of such cases ; but we are taught, by those 
who have most experience, and are of undoubted veracity, 
that great benefit, and, in some instances, entire relief, has 
been obtained by the use of remedies, in this disease. The 
remedies are in no wise peculiar, but are the common reme- 
dies of dropsy. It is to be recollected all the while, that the 
disease may continue indefinitely ; that it affects the health of 
the patient even less than other dropsies ; and that the reme- 
dies are not to be persisted in, or pressed to a dangerous de- 
gree of activity. 

The first remedy recommended, is bloodletting; and this 
should be performed by means of leeches. It should not be 
repeated more than once or twice, and the leeches used should 
not be more than three or four at a time. 

Calomel, in combination with squills, is the next, and, I am 
persuaded, a great deal the most important remedy. Take of 
calomel ten grains, squills twenty grains, divide into twelve 
powders. To a child two years old, half of one of these pow- 



DROPSY OF THE BRAIN. 219 

ders may be given in syrup, and repeated twice in twenty- 
four hours. This forms a reasonable amount of the remedy ; 
and it may be continued for a considerable time, if it does not 
produce salivation, or operate too actively on the bowels. If 
it produces salivation, it should be immediately suspended ; 
and, if no amendment attends it, the remedy should be aban- 
doned. But if, from a diligent attention and admeasurement 
of the head, the disease is found to give way, and the head to 
lessen, the remedy is to be laid aside only for a time suffi- 
cient for the symptoms of salivation to abate. It should then 
be resumed and persisted in according to circumstance's. 

A more active use of calomel and squills has been tried, and, 
in some instances, thought to have acted beneficially. The 
remedy, in this case, is used as an active diuretic, and cathar- 
tic. The doses I have mentioned should be doubled, and re- 
peated at shorter intervals, so as to produce copious dischar- 
ges from the bowels, and by way of urine. Great prostration 
will attend this course ; but there is reason to believe, that the 
swelling may be reduced by it, when a more moderate use of 
the same remedies would fail. 

When, by these means, the patient is greatly relieved from 
the swelling, and the absence of fever admits of the use of tonic 
medicines, preparations of iron should be administered. Five 
drops of muriated tincture may be given in water, two or three 
times a day. Generous food, in moderate quantity, may also 
be allowed ; and there is reason to hope, that, even in these 
desperate cases, a perfect cure may be thus accomplished. 

There are yet other remedies which may be used in dropsy 
of the brain. Pressure, which would seem to be the least ap- 
plicable where its action must be immediately on the brain, 
has been found very beneficial, in some cases of this disease. 
It is easily made by means of a roller passed around the head, 
with occasional turns under the chin and over the crown ; but 
this is obviously not a very equal, or perfect mode of applying 
pressure to the head. Many contrivances have been resorted 
to, to accomplish the object better ; but I have had no opportu- 
nity of trying them, and should apply the bandage, with due 
care not to make the pressure so great as to destroy the senses 
of my patient. It is asserted that pressure used in this way, 
has, in many instances, proved exceedingly beneficial. It 
should be tried with watchfulness and care, and abandoned 
if found not beneficial. 

Tapping has been found a remedy of some value, in ex- 
treme cases of this disease. The fluid contents of the skull 



220 INFLAMMATION OF THE EYE. 

have been let out by a trocar or even by a common lancet. 
The remedy cannot be recommended except in extreme cases, 
and where death, without its use, would seem to be impend- 
ing. In some instances, there would be but little difficulty in 
performing the operation ; for the water approaches so near 
the skin, that the head, when placed in the sun under favora- 
ble circumstances, has a transparent appearance. The deli- 
cacy of the brain is such, that this operation should never be 
attempted except by an experienced surgeon, and anatomist — 
it is sufficiently dangerous even in the best bands. The fluid 
extracted should not be considerable at one time; but the 
flowing should be checked, and renewed, from day to day, 
till the whole is discharged. 



DISEASES OF THE EYE. 

This organ, so exceedingly important in the purposes of life, 
and subject to some of the diseases which call for the most 
delicate and important operations in surgery, is yet subject to 
many disorders which call for ordinary medical prescriptions. 
I shall not attempt to go extensively into the consideration of 
these diseases, but satisfy myself with describing only such as 
are of frequent occurence, and do not require very important 
surgical operations. 



INFLAMMATION OF THE EYE— SORE EYES. 

The membrane which lines the eye lid, and is reflected over 
the eye ball, up to its transparent part, is very subject to in- 
flammation from cold, or other common causes. It is also sub- 
ject to be inflamed by the irritation of matters thrown into the 
eye, whether from their caustic properties, or rough, hard and 
pointed forms. This inflammation, in common cases, limits 
itself to this thin membrane, and does not penetrate into the 
substance of the eye, or even into its coats which lie imme- 
diately in contact with the part affected. The disease is, in 
itself, very slight; but the interuption which it produces in the 
uses of the eye, and its contact with an organ so exceedingly 
important, make it a subject deeply interesting to the sufferer; 
and, from this cause, it is very commonly brought to the atten- 



INFLAMMATION OF THE EYE. 221 

tion of the physician. When the disease extends to the deeper 
seated tunics of the eye, it becomes exceedingly dangerous, 
and should, with great care, be discriminated from the mild dis- 
ease, we are now considering. 

It will not always be in our power to assign the true cause 
of inflammation of the eye. It has been suggested that ex- 
posure to cold, and injury from caustic or mechanical sub- 
stances, were the most common causes; but there is some- 
times, in the atmosphere, a cause entirely different from these — 
an epidemic constitution of the air. This is not very often 
present, and never, so far as I know, extends over very exten- 
sive districts of the same country at the same time; but I have, 
in several instances, seen the disease so common, and extend- 
ing to so many persons who could offer no reason for the at- 
tack, that I think there can be no doubt, in assigning to it an 
epidemic character. 

The first symptom of sore eyes is an itching, commonly of 
one, but sometimes of both eyes. The patient is observed to 
be rubbing the eyes almost incessantly, while the tears begin to 
flow, requiring to be wiped away. Very soon a pricking sen- 
sation, as if sand or some small substance had got under the 
eye lid, and every motion of the eye or the lid produces most 
rasping and painful sensations. So strong is this feeling, that it 
is often impossible to convince the patient that he has not got 
some foreign body in the eye ; and he will require search to be 
made for it. The pain is however slight, and even light is yet 
tolerated by the eye. The tears do not long continue to flow, 
and the lids become gluey, and disposed to adhere together at 
night. The vessels of the eye become loaded, and the whole 
organ, except its transparent part, becomes exceedingly red, 
sometimes blood-shotten. The secretions of the eye itself be- 
come thicker, forming at first a transparent mucous ; but. after 
a while, the discharge is more or less colored. The swelling 
does not extend to the eye lid, and when the case is well treat- 
ed, although the disease may be sharp and painful, the eye is 
in little danger. 

TREATMENT. 

This disease is a simple inflammation ; but it affects a part 
in which inflammation has a limited degree of activity. Pru- 
dence requires, in these cases, the strictest avoidance of every 
thing which might aggravate the disease. The patient should 
withdraw from his ordinary pursuits ; place himself in a room 
sufficiently obscured from the light, and of a temperature rea- 



222 INFLAMMATION OF THE EYE. 

sonably cool. A dose of some light cathartic should be given, 
a few grains of calomel followed by a Seidlitz powder, or cas- 
tor oil, will answer as well as any other. His diet should be 
spare. By these remedies and restrictions the disease often, 
without any other treatment, will soon pass off. 

The local remedies which should be used in this inflamma- 
tion of the eye, have been a matter of much controversy, and 
even yet, can hardly be said to be agreed on. Astringent sub- 
stances have long been applied to the eyes, in this disease — 
alum has been the most extensively used. In this country it is 
very common to take the white of an egg, and rub into it a suf- 
ficient quantity of alum to make it into a firm coagulum, or 
curd. The eye is closed and this curd bound over it as a poul- 
tice. In place of this, medical men have been in the habit of 
making an eye water, from sugar of lead and sulphate of zinc, 
or white vitriol. Take of sugar of lead thirty grains, white 
vitrol ten grains, disolve in two ounces of water, let it be 
shaken together and set by, till it has become transpa- 
rent — it should then be poured off without shaking, into anoth- 
er phial for use. Let the patient turn his head back, and drop 
a drop or two of this solution in the eye, taking care that the 
position of the head is not so changed, that the remedy will 
run off, without entering the eye : the patient should then be 
requested to endeavor to open the eye, and if he cannot effect 
it, the lids should be raised by the finger of his assistant. He 
will be sensible when the solution has passed under the eye 
lid, and for sometime some smarting will follow it. It is use- 
less to multiply examples of these astringent eye waters. Those 
we have mentioned are as good as any other. I have but a 
word of counsel to offer on their use, and that is, that they 
should not be used within the first two or three days of the at- 
tack, for I can say without any hesitation, that when used too 
early they aggravate the disease. 

If the mildest course of treatment is resolved on, it is to be 
found in cool application, made by means of a bit of linen 
dipped in cold water, and kept constantly on the eye. A mild 
poultice made of corn meal and applied cold may be substi- 
tuted ; or, if it can be easily procured, the bark of slippery 
elm, the best of all poultices, may be tried. This course of 
treatment should be pursued for two or three days ; after which 
a cautious use of the astringent remedies which have been 
mentioned, may be made. The eye water of sugar of lead 
and vitriol, may, for example, be reduced to half its strength, 
and used morning and evening. 



FURULENT INFLAMMATION OF THE EYE. 223 

For many years I pursued the above mode of treating sore 
eyes, and was satisfied with the general safety to the organ, 
and the reasonably short time of the cure ; but I may not quit 
the subject without stating that the treatment of this disease 
has of late been greatly altered, and, as 1 think, improved. I 
shall offer the nevv remedy, with the observation that since its 
promulgation, it has not occurred to me to test its use in a great 
manv instances. Where I have tried it, I have been well sat- 
i.sfied with its effects, and do not hesitate to recommend it. 
This improvement in the treatment of a harrassing and pain- 
ful disease, has the great advantage of being exceedingly sim- 
ple, requiring very little discrimination as to the time at which 
it should be used. 

The new remedy is the common, though powerful styptic, 
nitrate of silver, or lunar caustic. Four grains of nitrate of 
silver are to be disolved in an ounce of water ; if the water is 
impure and forms a white cloudy solution, the quantity of the 
caustic should be increased to five or six grains. This solu- 
tion is to be dropped into the eye, and care taken that it passes 
to every part of it. The pain which attends it is for a mo- 
ment sharp, but passes off in a few minutes. This powerful 
remedy may be justly pronounced less painful than others 
which seem exceedingly mild. Its beneficial effects will be 
presently obvious ; the sensation as of gravel in the eye, will 
cease, and the symptoms will be altogether moderated. The 
remedy should be repeated daily, as long as its use seems to 
be required. But, in many instances, after six or eight hours 
from its use, the symptoms of the disease will return, the pa- 
tient will again feel as if sand had got into his eye; in such 
cases the remedy should be repeated even twice or thrice a day. 

This simple mode of treating common sore eyes has been 
found so efficient, that it has in common cases caused the aban- 
donment of every other means of cure. I think there should 
be no longer any hesitation in bringing it into common use. I 
consider four grains to the ounce a weak solution of caustic. I 
have used it ten-times this strength. 



PURULENT INFLAMMATION OF THE EYE. 

When the deeper seated tissues of the eye become inflamed, 
the disease has been called purulent, because of the extensive 
formation of pus or matter which takes place in it. The seat 
of this inflammation is the solid coats which compose the wall 



224 PURULENT INFLAMMATION OF THE EYE. 

of the eye, and which form what is commonly called the white 
of the eye. The disease, in its severest form, involves almost 
the whole organ, except the nerves and internal structure. It 
is exceedingly violent, painful and dangerous. 

The inflammation of the eye which we are about to describe, 
does not attack, in the first instance, the superficial vessels 
which are inflamed in common sore eyes, but the deeper seated 
vessels which, in health, circulate only the white or transpa- 
rent portions of the blood. On inspection, the white of the eye 
will appear to have acquired a reddish or pink color, and the 
vessels will be seen passing, like rays or hairs, around the trans- 
parent portion of the eye. A sense of tightness and pain is felt 
in the globe of the eye, which looks heavy and watery ; and 1 
have seen, in a very early stage of the disease, a reddish tinge 
of the watery humours contained in the eye. As the disorder 
increases, the pain becomes worse, and extends to the head, 
where it is felt throbbing with great violence ; it progresses 
with considerable rapidity, and fever is soon brought on. The 
swelling extends from the eye to its investing membranes, and 
then to the eye lids which soon become closed, so that they can- 
not be easily opened. In many instances, matter forms under 
the lid, which cannot escape through the opening in the eye 
till it is raised, and then it gushes forth in considerable quanti- 
ty. In two or three days the suppuration is commonly at its 
height, and great mischief is taking place in the coats of the 
eye. On examination, a fissure or furrow will be seen passing 
around the edge of the transparent part of the eye, which 
sometimes passes through, allowing the fluid contents of the 
eye to escape — in other words the eye bursts. In a few in- 
stances, matter forms within the globe of the eye, and after the 
disease has subsided and the eye opened, the pus is seen in the 
bottom, while the upper part of the chamber is transparent, 
admitting of the passage of light ; but the vision is destroyed. 

This form of inflammation of the eye, is sometimes induced 
by the accidental or incautious contact with the matter pro- 
duced in gonorrhea. It is epidemic in the glaring sunny dis- 
tricts of the East, and is justly a greater source of dread to 
the armies of Europe when invading Egypt and certain dis- 
tricts of India, than the plague or the cholera. It has been 
disputed whether the disease is contagious ; and, still more, 
whether it is so infectious, in any instance, as to arise from 
coming too near to those affected with the disease. Circum- 
stances have led to the belief that the disease will be propa- 
gated by contact with the matter it produces. And care 



PURULENT INFLAMMATION OF THE EYE. 225 

should be taken, that the eyes of the well are not touched with 
the matter which has been produced by the disease. 

TREATMENT. 

This disease is to be considered one of extreme danger, not 
indeed to life, but to an organ almost as dear as liie. Unfor- 
tunately the physician is seldom called till the disease has 
made too much progress to be successfully arrested ; for the 
disorganization which is fatal to the functions of the eye, some- 
times begins within a day or two of the commencement of the 
disease. But the maxims which govern in the treatment of the 
disease, are founded on the supposition of its high inflamma- 
tory character, and the knowledge, from experience, that un- 
less the remedies applied are of great power, very little effect 
can be reckoned on, from them. The first remedy to be em- 
ployed is bloodletting ; and it should be employed promptly, 
and copiously, not to excite fainting, but to reduce the quanti- 
ty of blood — from one to two pounds should be taken. 
This remedy has been found, on great experience, less to be 
depended on, than might be expected ; but still, experience 
has not supplied us with a better. Cathartic medicines have 
been extensively used, and should be of the most active kind. 
Twenty grains of jalap and a drachm of cream of tartar, may 
be given, every two or three hours, till it operates as a cathar- 
tic. Other and milder cathartics may be used ; but there is 
no necessity for pointing them out. Cooling poultices applied 
over the eyes, will be found beneficial ; but I object to the use 
of such astringents as alum, sugar of lead, or white vitriol. 
Blistering behind the ears, or at. the nape of the neck, has been 
found beneficial. Emetics have not been recommended, from 
the fear, that in the action of vomiting, a particular force might 
be given, which might tend to the bursting of the globe of the 
eye, when ulceration had taken place. This fear, I think, 
rests on but a feeble foundation ; and I should not hesitale to 
commence with the antimonial mixture, immediately after the 
operation of the cathartic. The mixture should be given in 
such doses as will not operate as an emetic ; but should it do 
so, it will not increase the danger. It may be repeated, from 
time to time, while the high and inflammatory state of the dis- 
ease seems to require it. Some have recommended calomel, 
and rubbing with mercurial ointment, for the purpose of indu- 
cing salivation ; but the mischief which arises from this dis- 
ease, happens too suddenly to admit of our relying on such a 
15 



226 SCROFULOUS SORE EYES. 

remedy ; the eye will be destroyed before the salivation takes 
place. 

The great benefit which has been derived from the use of 
lunar caustic, in common sore eyes, has pointed it out with 
great favor, as a remedy in the disease under consideration. 
It should be used of greater strength, and forced into the eye 
by means of a small syringe. Take ten grains of lunar caus- 
tic, and dissolve it in an ounce of water, to be used in this way, 
as an injection in the eye. Since I have witnessed the effects 
of this remedy in minor cases of inflammation of the eye, I 
have had no occasion to test its efficacy in the alarming cases 
of which we are speaking ; but I should not hesitate to use it, 
should the necessity for it present itself. 



SCROFULOUS SORE EYES. 

This affliction is met with most commonly in children, be- 
tween the ages of two and eight or ten years. It is rare in 
this climate, and I do not recollect to have met with more than 
two well marked cases. It is said to attack only children of 
a scrofulous habit, and to be in many instances, the first evi- 
dence of the existence of this habit. The existence of such a 
habit of the constitution, is not always so well marked as to be 
easily identified ; but the disorder of which we are treating, 
bears a character which maybe easily known. 

In its first appearance, the inflammation of the eye now un- 
der consideration, produces a redness, or increased vasculari- 
ty of the outer membrane of the eye ; but sometimes the red- 
ness concentrates in patches, forming several little pustules 
which finally ulcerate, and are very irritable. The eye ac- 
quires great intolerance of light, and the patient is seen shield- 
ing his eye with his hand, and distorting his features in every 
way to protect the eye. The general health is but little dis- 
turbed, no swelling of the lids of the eye takes place, and the 
patient, although suffering so much from the effect of light, 
does not voluntarily submit to confinement. When the dis- 
ease is worse, the tears flow from the eyes over the face, in- 
flame the skin, and produce thin crusts or scabs which some- 
times become extensive. The disease is exceedingly slow in 
its progress, and difficult of cure. 

This disorder is to be treated with reference to the general 
health of the patient. Where there is fever present, the treat- 



I 



SCROFULOUS SORE EYES. 227 

ment is to be commenced by the use of mild cathartic medi- 
cines. Take of rhubarb a drachm, calcined magnesia, a 
drachm, rub together and divide into four powders ; of these 
powders, one may be given, every four hours, till they operate 
as a cathartic. After this, a generous food should be allowed, 
and the child protected from cold by warm clothing. The eye 
should, as much as possible, be protected from the light ; but 
from the obstinacy of the disease, and its chronic character, a 
rigid confinement during the cure, cannot be recommended. 
Tonic medicines are also advised, and of these the prepara- 
tions of iron are the best. Eight or ten drops of the muriated 
tincture of iron, may be given twice a day. Sulphate of qui- 
nine has of late acquired great reputation, as a remedy in this 
disease ; two or three grains a day, given in doses of half a 
grain to a grain, will be sufficient. 

The local treatment of the disease is a matter of more trou- 
ble, and equally important. The ulcers, if they have formed, 
are hard to heal. The remedy most relied on in their treat- 
ment, is a solution of lunar caustic ; four grains of this medi- 
cine may be dissolved in an ounce of water, and applied, eith- 
er by droping it into the eye, or touching the ulcer by means 
of a small mop or camel-hair pencil. This remedy should not 
be repeated more than once in two or three days ; and we 
are told that there is danger if continued too long, of its pro- 
ducing a permanent discoloration of the white of the eye, 
which has, in some instances, been turned to a dingy brownish 
color. This effect of caustic, I have never witnessed, and do 
| not think it very easily brought on. The tenderness of the eyes 
in this disease, has led to the use of opium, as a local applica- 
tion. Take of laudanum a tea spoonful, unite with it four tea 
spoonsful of water, shake this together, and drop it into the 
eye, as in the common application of remedies of this kind. A 
preparation made by steeping opium in wine, is preferred to 
this, and is applied without the' addition of any water. If the 
case proves obstinate, I have directed, with great benefit, the 
application of the laudanum without any dilution, by droping 
a drop or two of it in the eye, from the phial. The irritation 
it causes is momentary, and I never have seen any permanent 
ill result from it. 



228 INFLAMMATION OF THE IRIS. 



INFLAMMATION OF THE IRIS. 

This disease is seated within the globe of the eye, affecting 
the iris, or that portion of it, which contracts around the pupil, 
and through which light is let into the eye, for the purposes of 
vision. This organ is exceedingly small in its dimensions ; but 
small as it is, its diseases are exceedingly important, involving 
the uses of the eye. The diseases of this organ were long 
misunderstood and ill treated ; but they are now considered as 
manageable as other diseases of the eye, and they furnish 
probably as many instances of sight saved by remedies, as any 
other disease of the eye. 

Inflammation of the iris, when caused by accident, exposure, 
surgical operations, or other common cause of inflammation, is 
a very acute disease, running its course in a very short time, 
and not unfrequently destroying the sight. But when it arises 
from remote causes which are chronic, it also takes up a chron- 
ic character, and is to be treated accordingly. The most com- 
mon of these remote causes is syphilis ; but it is thought to 
arise, in some instances, from rheumatism, or other chronic com- 
plaints. Fatigue of the eye is another cause, and the one, I may 
say, from which I have chiefly witnessed its occurrence. The 
protracted exertion of the eye in fine needle-work, has pro- 
duced it in many cases, and it is said to have occurred fre- 
quently to engravers, and others whose mechanical employ- 
ments are particularly fatiguing to the eye. 

The symptoms of this disease, although long overlooked, are 
very well understood. Some degree of redness in the white of 
the eye is obvious ; and, on a close inspection, it will be found 
pale, and without the the loaded vessels of an ordinary inflam- 
mation of the eye. The transparent part of the eye will look 
dull, but still be sufficiently transparent to admit of the exam- 
ination of the parts within. The color of the eye, or of the 
iris, which is the seat of color in the eye, will be somewhat 
changed ; it will be reddish in those whose eyes are of light 
blue. But the most unerring sign of its presence, is the alter- 
ation in the pupil itself, which becomes sometimes triangular, 
or otherwise misshapen, and, not unfrequently, immovable. In 
other instances, it contracts to a very small point, or closes en- 
tirely. The pain which attend^ this disease is sometimes 
slight, but in other cases severe and greatly aggravated at! 
night ; it is sometimes attended with but little fever, but this is 



INFLAMMATION OF THE IRIS. 229 

not always the case ; for, in some instances, the pulse becomes 
exceedingly strong and hard, and the feverish heat considera- 
ble; the pain frequently extends to the head and to the parts 
contiguous to the eye. 

TREATMENT. 

This disease of an organ so small as to be scarcely an inch 
in diameter, affects tissues strictly resembling the larger closed 
cavities of the system, such as the cavity of the abdomen and 
of the thorax. The remedies employed in its cure, bear also a 
strict analogy ; but it is to be remarked, that the remedies are 
by no means to be regulated bv the size of the organs affected. 
This inflammation of the eye is to be treated with the same 
promptness and effectual remedies, which would be lequired in 
pleurisy. 

The first remedy to be used is bloodletting, which should be 
performed by taking irom the arm a pint of blood, or more, ac- 
cording to circumstances. If the disease is protracted, it may 
become necessary to use local bleeding by means of cups on 
the temple. Bloodletting will commonly give prompt relief 
to the symptoms of this disease ; but this relief will be tem- 
poral}* unless other remedies are used. 

A brisk cathartic should be given in the commencement of 
the disease ; and I know none better than cream of tartar and 
jalap. But this should be followed bv the use of calomel, 
which is considered the most important remedy in the disor- 
der. It is to be given for the purpose of exciting a speedy 
salivation, and where the patient has an ordinary share of 
strength, he may take ten grains a da}' divided into three or 
four doses. If it operates briskly as a cathartic, opium should 
be combined with it ; twenty drops of laudanum, for example, 
once or twice a day, as the case may seem to require. This 
course is to be pursued till salivation comes on ; and, in acute 
cases of the disorder, the salivation ought to be considerable, 
and copious spitting with much soreness of the mouth, brought 
on. But where the disease is chronic, and has existed for 
many weeks, this remedy should be used with corresponding 
deliberation. Take ten grains of calomel, and five grains of 
opium, in powder ; make into twelve pills ; of these pills, give 
three a day till a slight salivation is brought on. It is agreed 
that when salivation takes place, the disease, if curable, will 
instantly show signs of amendment, or its symptoms will les- 
sen and gradually give way. 



230 AMAUROSIS. 

There is another remedy which has been used with great ad- 
vantage, in this disease. This is belladonna, one of the strong- 
est of the vegitable narcotic poisons. It had been long observed 
that this article, when applied to the eye, caused a temporal 
enlargement of the pupil; and, when the application is made of 
great strength, the iris so expands as not to be seen, leaving 
the whole of the internal structure of the eye exposed to the 
light. This effect of belladonna on the iris, has been made 
available in hindering the contraction of the pupil in this dis- 
ease. It is to be applied, from time to time, according to the 
urgency of the symptoms. Twenty grains of the extract of 
belladonna, may be rubbed with a little water, so as to form a 
very thin pasty fluid ; this may be rubbed on the lids and 
around the eye ; it should be washed off in about an hour. A 
watery infusion of the extract is made by adding a greater 
quantity of water, and straining through linen. A drop of this 
in the eye, has a more powerful effect on the iris, and excites 
neither inflammation or other inconvenience. It is a matter of 
discretion in the practitioner, how often, and to what extent, 
this remedy should be used. The object of using it is, to hin- 
der the contraction of the pupil which sometimes ends in clos- 
ing it up; or the adherence of the iris to the parts below — in 
either case the ey r e is injured or destroyed. The remedy, it is 
obvious, ought not to be too often repeated; for when the iris 
is inflamed, the adhesion may form, as well in its expanded, as 
in its closed state ; it ought, therefore, not to be allowed to re- 
main too long closed, or two long expanded. And it is stated, 
that injury has happened, in some instances, from the adhesion 
of the iris when expanded, in such a manner, that its contrac- 
tions were never recovered. This however is a less evil than 
the closing or shutting up of the pupil. 



AMAUROSIS. 

This disease is blindness, without any defect in the organ of 
vision which can be made obvious by inspection, either before 
or after death. It arises sometimes from obvious causes; the 
exposure of the eye to the glaring light of the sun, has been 
known to produce it; a sudden flash of lightning occurring in 
the night, has done the same thing; but the most frequent of its 
causes, is, over fatigue of the eye, either in the examination of 
minute objects, or in intense and long protracted reading, or 






AMAUROSIS. 231 

other similar employments. In other instances, it arises with- 
out any obvious cause ; sometimes suddenly, but more fre- 
quently very slowly. 

When this disease is brought on by a sudden shock of the 
nervous system, or a sudden exposure of the eye to an intense 
light, the blindness is sudden, and sometimes complete. But 
in instances in which its approach is slow, the defect is, at first, 
very slight; it presents itself in the appearance of small, black, 
floating specks, as if of soot, in the atmosphere. They are 
seen, from time to time, and gradually increase in size, till at 
last they become so extensive as to entirely obscure the light. 
Commonly one eye is affected first ; but, in a short time, both 
are involved in the same calamity. Very little pain is com- 
monly felt, and the health of the patient remains unimpaired. 
There are a lew instances in which the disorder is connected 
with an extensive state of paralysis, which affects the limbs, as 
well as the eyes. 

TREATMENT. 

Although this disease is not attended with pain, it is thought 
to depend, almost always, on an inflammatory disease, attack- 
ing the nerve, or the parts which immediatelv invest it in the 
bottom of the eye; it is, therefore, to be treated as an inflam- 
mation, by the use of bloodletting, cupping, cathartic medi- 
cines, and a very low reaimen. But. in addition to these, the 
use of mercury has been found of more service than everv 
other remedy which has been heretofore tried. If the case has 
happened suddenly, a salivation should be brought on as quick- 
ly as possible, by the use of from ten to fifteen grains of calo- 
mel a day, divided into three or four doses. It should be hin- 
dered from passing off by a cathartic operation, by the use of 
laudanum ; twenty drops, as often repeated as it may be found 
necessarv. When the disease is slow in its attack, mercury is 
nonetheless important; it is to be given to accomplish the 
same purpose, a salivation* but it is best to administer it in 
a more gradual manner, and to suspend it as soon as the sali- 
vation appears. Pills containing one grain of calomel each, 
may be given evening and morning. By this means the in- 
flammatorv cases of this disorder are frequently cured ; in- 
deed, if the remedies are used without delay, a cure may be 
reckoned on with some confidence. 

It is acknowledged that the cases which happen from pros- 
tration and weakness, and in consequence of a particular weak- 
3 of the nervous power, are rare; when they occur, they 



232 EAR ACHE. 

will be known by the general symptom of debility, and per- 
haps partial paralysis, which may be present. They are to be 
treated on apian entirely opposite from that which has been di- 
rected above. The patient is to be allowed nutricious food, 
and remedies of a supporting and tonic kind; twenty drops of 
muriated tincture of iron, twice in a day will answer. These 
supporting remedies may be varied as the taste of the patient 
and the opinion of the practitioner may require. In cases of 
such long continuance as these are likely to be, a single reme- 
dy should not be continued for too great length of time. 



EAR ACHE—OTALGIA. 

Pain in the ear is a very common complaint, and very fre- 
quently passes off without producing any injury to health, or 
to the organ of hearing. But cases do occasionally happen in 
which, ear ache, and its consequences, become tedious, trouble- 
some, painful, and dangerous. Our knowledge of the subject 
is at best imperfect, but a few remarks on it, may be useful to 
some of our readers. 

Through a winding passage from the back part of the throat, 
there is an opening into the chamber of the ear, or true organ 
of hearing. The external air through this opening, comes in 
contact with the nerves of hearing, in a manner no where else 
admitted in the structure of the body — all other nerves of sense 
are protected by covering more or less thick. This exposure 
of the nerves may account for the frequency of pain in the 
ears, after exposure to cold, and damp winds. This is the 
most common cause of pain in the ears; But this organ is sub- 
ject to pain from causes peculiar to itself. Sudden impulses 
made on the ear by the firing of cannon, or other loud noises, 
often produce violent pain in the ears. These, and other cau- 
ses, give rise to pain and inflammation, but the progress of the 
disease, will be governed by the circumstances attending the 
case. 

Ear ache is much more common in children than in grown 
persons. The descriptions we receive of it are therefore com- 
monly imperfect. It is often a temporary disease, attacking 
the child at night, after it has played in the cold wind, and ter- 
minating before morning. The pain is, in these cases, severe, 
often agonizing, but ceases rather suddenly, leaving the child 
to sleep, without much disturbance, till morning. Some de- 



EAR ACHE. 233 

gree of deafness is apt to follow these attacks ; but nothing 
seems to be demanded as a remedy, and the deafness gradu- 
ally subsides. These cases, painful as they are, do not seem to 
be attended with any inflammation. 

The pain which attends the inflammation of the ear, does 
not differ widely from the above described, ear ache. It does 
not however, subside in a few hours ; but fever makes its ap- 
pearance, and the symptoms become aggravated. They some- 
times become very violent, producing delirium, and a fever of 
highly inflammatory symptoms. These symptoms sometimes 
continue till suppuration takes place in the ear, with a rupture 
of the tympanum and a discharge of matter through the ex- 
ternal opening. 

Great injury to the internal organ of hearing frequently fol- 
lows this formation of matter. The bones of the ear, are 
sometimes destroyed and escape, and caries of the skull some- 
times, though rarely, takes place. The danger to the ear, and 
to life itself, is sometimes very great, but we are often surpris- 
ed to find, that with a great amount of internal injury, frequent 
and long protracted suppurations, and great pain and suffering, 
our patients still retain the sense of hearing. Total deafness 
is seldom produced by these cases of inflammation and sup- 
puration of the ears. 

TREATMENT. 

Sudden attacks of ear ache are to be treated with anodynes. 
Take a tea spoon nearly full of sweet oil, drop into it twenty 
drops of laudanum, and mix together with the finger. Pour 
this into the ear, and fill with wool, or cotton. Or the same 
purpose will be accomplished by dipping the lock of wool in the 
oil, and putting it in the ear. Lay a warm brick on the bed, 
and lay the child with its ear near it. The pain will probably 
cease in an hour or less. Where the pain is violent, give a 
dose of laudanum before putting any thing in the ear. If the 
sweet oil is not at hand, lard, a little warmed, will do in its 
place. 

Where the pain arises from inflammation, its attack is usu- 
ally less sudden ; but it continues longer, and gives rise to fe- 
ver, and sometimes delirium. These cases require a different 
treatment. A brisk cathartic, of calomel and jalap should be 
given, and a blister applied behind the ear. The blister should 
be cut, to fit the part back of the ear, which is without hair. 
It need not be larger than half a dollar. If the pain is extreme, 
and the heat and fever are considerable, leeches applied near 



234 INFLAMMATION OF THE MOUTH. 

the ear, or bloodletting may be advisable ; but unless these 
remedies are used at an early stage of the complaint they 
might as well be omitted. 

In spite of the remedies we have mentioned, inflammation 
of the ear frequently produces suppuration; and, after a week 
or more of agony, the matter is seen to flow from the ear in con- 
siderable quantity. This state of things does not call for any 
active treatment. Cleanliness is the first consideration. When 
the discharge subsides, so as to allow of it, a lock of cotton or 
wool should be put in the ear. This is necessary, to hinder 
the passing of insects into the ear, and may be useful to pro- 
mote cleanliness. After a few days, if the discharge contin- 
ues, take a weak solution of castile, or shaving soap, and throw 
it into the ear with a syringe. This operation is to be carefully 
done with a small syringe, and very little force used, as the 
operation of the stream on the tender organs of the ear, may 
produce pain. In this wav, the ear may be washed out daily, 
and cleanliness observed. These cases become tedious, and 
annoying, but there is little more to be done, but to wait for 
the operations of nature, and to observe neatness and clean- 
liness. 

If the patient, affected with ear ache or suppuration, and 
running from the ear, has, at the same time, any other disease, 
or if, from the long continuance of the discharge the health 
gives way, a system of general remedies is to be adopted, 
suitable to these disorders. The food should be rich and 
nourishing, and wine or toddy given in moderation, once or 
twice a day. If the exhaustion and weakness are considera- 
ble, preparations of iron, or vegetable bitters, become neces- 
sary. 



INFLAMMATION OF THE MOUTH— STOMATITIS. 

The original diseases which attack the mouth, are few ; but 
these cannot all be clearly delineated without division. 

SIMPLE INFLAMMATION OF THE MOUTH. 

This is, for the most part, a disease of early infancy, milder 
than thrush, but, in other respects, much resembling it. But 
it is not confined to the age of infancy or childhood ; it may 
occur at any period of life. 



INFLAMMATION OF THE MOUTH. 235 

CAUSES. 

The violent action of the muscles of the mouth, in drawing 
the breast, is often the only obvious cause for inflammation on 
the tongue and lining membrane of the infant's mouth. But 
teething and its attendant disorders, are a more frequent cause, 
an I give to it the chief title it has to a separate consideration. 
It is obvious also, that as this is a simple inflammation ; it may 
arise from violence, or the application of fire, or caustics of 
any kind. 

DESCRIPTION. 

Heat, redness, swelling, pain, and a copious flow of saliva, 
are the common symptoms of this disease. When it occurs 
spontaneously in early infancy, its duration is short, common- 
ly not more than a week. It produces some difficulty in swal- 
lowing, and apparently pain in drawing the breast, but not of- 
ten cracks in the lips, and a spreading redness around the 
mouth. The ulceration and gangrene, which are said to at- 
tend it in rare instances, I think belong more to the disorders 
we are }^et to speak of, in this chapter. 

TREATMENT. 

A mild cathartic of rhubarb and magnesia, given every 
second or third day, has, in my practice, generally proved suf- 
ficient to relieve this disorder. But it sometimes holds on lor 
a week under this treatment, and I resort to calomel as a 
more powerful remedy. The local disorders of the mouth re- 
quire particular attention, at the same time. The swelling 
which sometimes occurs about the root of the tongue, or in the 
glands near the angles of the jaws, requires remedies. Leech- 
es are necessary, if the inflammation is so high as to render 
suppuration probable. But I have met with no case in which 
I was not satisfied with the application to the throat, of a sim- 
ple poultice of corn meal or light bread, boiled in milk. It 
should be applied cool, and renewed twice a day. This cause 
I think greatly preferable to the stimulating liniments I have 
known advised. These remedies are sufficient, in ordinary 
cases ; but when, in older persons, unsound teeth, or the ef- 
fect of any stimulant improperly used, is ascertained to operate 
as a cause of the complaint, they should of course be removed. 

WHITE THRUSH CURDY STOMATITIS. 

This is a disease of early infancy, occurring in more than 
half the children born in this country, and without any obvi- 



236 INFLAMMATION OF THE MOUTH. 

ous cause. I have witnessed its progress through many fami- 
lies, and have seen children of the same parents, have or es- 
cape it, without any proportion to number ; a single one of a 
whole family being, in some cases, the only sufferer ; and, in 
others, perhaps a single one escape. I have not been able to 
satisfy myself of the truth of the common belief, that this dis- 
order is contagious. In this country, it is common for healthy 
mothers to nurse the babes of others, who have a deficient 
supply of milk for their support. This is never done, if the 
suffering babe is known to have the thrush- But, in many 
cases, the thrush breaks out in both children ; and I have of- 
ten known the healthy mother charge to her beneficence, the 
breaking out of this disease in the mouth of her own child. 
There can be no doubt, that the nipple of the mother is fre- 
quently inflamed by suckling a child having this disease. This 
inflammation spreads in a ring around the nipple, and is, for a 
time, very tender, but never produces ulceration or cracks. 

DESCRIPTION. 

A deep red, and inflamed appearance of the tongue, and 
lining membrane of the mouth, with but little tenderness, and 
no swelling, announce the approach of thrush. Soon, small 
white specks appear, and gradually increase in size, running 
together in patches, especially towards the root of the tongue. 
This eruption has been called curdy, and nothing can be more 
descriptive, for its resemblance to curdled milk, is altogether 
striking. It adheres slightly to the tongue, or lining membrane 
of the mouth; and, if detached, discloses no ulcer, nor induces 
any discharge. I have seen a young mother, mistaking this 
disease for curdled milk, busily engaged in rubbing it off with 
the corner of a rough towel. The child screamed from pain, 
but no blood flowed — no discharge or swelling succeeded, but 
apparently the inflammation and tenderness were, for a day or 
two, aggravated in a slight degree. The eruption is apt to 
return, if, by any means, it is rubbed off, and sometimes con- 
tinues for several weeks. The curdy matter, however, be- 
comes less and less, and the mouth dries as the case continues. 
The bowels become disordered — fever ensues, and a red mar- 
gin appears around the anus, but without any resemblance to 
the eruption in the mouth. The child is now in a dangerous 
situation, and requires the best treatment. Few cases arrive 
at such a stage — the great majority terminating favorably in 
eight or ten days. Scarcely any thing else from disease, bears 



INFLAMMATION OF THE MOUTH. 



237 



much resemblance to the production, removal, and reproduc- 
tion of curdy thrush. The microscopic observations, which 
have, of late, been thought to prove this curdy matter to be a 
vegetable growth, have more plausibility than would, at first, 
seem probable. 

TREATMENT. 

In slight cases, where the bowels are not disordered, and 
the disease not much extended towards the throat, it is unnes- 
sary to give active remedies. Detergent applications of mude- 
rate activity, applied to the mouth with a rag, or, what is much 
better, a camel-hair pencil, commonly answer every purpose. 
Borax, the most common of all, is perhaps the best. It may 
be reduced to a fine powder, and rubbed up with sugar, one 
part of borax and four of sugar, the exact proportion being of 
little consequence. Honey may be used in place of the sugar. 
It may thus be applied, either dry or in the form of syrup. 
Vegetable astringents may be substituted, if the disease does 
not readily give way. The best of these is galls in infu- 
sion, or its near equivalent, oak bark, prepared in the same 
way — pour half a pint of boiling water on two drachms of 
powdered galls, or on an ounce of powdered oak bark. — 
Apply this to the affected part, daily, or, at most, twice a day. 

The diarrhoea which frequently attends the worst cases of 
thrush, requires special attention. It is commonly attended 
with severe pain in the bowels, if we may form this opinion 
from the frequent screaming and writhing of the patient. I 
have prescribed paregoric, in these cases, w T ith good effect — 
give five drops, to a child a month old, once or twice a day, 
according to the evidences of pain. Two grains of calomel, 
divided into three portions, may be given in twenty-four hours. 
If it seems not to operate, a tea spoonful of castor oil may be 
given the next day. If this seems to produce much pain in the 
bowels, avoid repeating it, and substitute rbubard and magne- 
sia. If these remedies do not stop the diarrhoea, and the pa- 
tient loses flesh and becomes very weak, commence a tonic 
and supporting course of treatment. Mix a tea spoonful of 
brandy, or other good spirit, in sugar and water, and give it in 
the conrse of six hours. Use also lime water, prepared chalk, 
or other absorbents in small doses. Vegetable astringents 
may be also used with benefit. Tincture of gentian may be 
given in doses of ten drops, in water, three times a day. Un- 
der this treatment, the thrush will seldom prove fatal. 



238 INFLAMMATION OF THE MOUTH. 
YELLOW THRUSH APHTHAE. 

This is a very common disease with children ; but so fre- 
quently happens in the course of dyspepsia, diarrhoea, cholera 
infantum, and other disorders, that I have serious doubt wheth- 
er it is ever an originial disease. Nor is it confined to the age 
of childhood ; it occurs at all ages, and almost always as an 
obvious attendant, or consequence of other diseases. 

CAUSES. 

Teething children, are by far more subject to this affection, 
than other persons ; and there can be but little doubt, that the 
disorders of this state, produce aphthae. I have also seen it 
so frequently in children of seven or eight years of age, that I 
have thought the obtainment of the second set of teeth, had its 
influence in producing it. But the disease is not confined to 
children, and must, therefore, arise from other causes besides 
teething. The most frequent of these is d}'spepsia. Few dys- 
peptic persons long escape aphthous eruptions. They occur 
irom time to time, and often disappear without the use of any 
remedy. In other cases, they are more permanent, and be- 
come confluent. 

Diarrhoea, especially when brought on by cholera infantum, 
is very often attended with this form of thrush ; but, in these 
cases, dyspepsia is also present, and may be the cause of the 
aphthae. I feel the more disposed to attribute this disease to 
a prior, or coexisting disease in the stomach, from the observa- 
tion of Doctor Beaumont, who found his patient, St. Martin, 
when disordered by excess in eating, to have aphthae on the 
mouth and tongue, and, at the same time, a similar eruption in 
the stomach. Dysenter}', typhus fever, and consumption, are 
said to be frequently attended with aphthae ; but it has not hap- 
pened under my notice. 

SYMPTOMS. 

An inflamed appearance of the mouth, with points of ex- 
treme redness and a little elevation, may be noticed, as the 
onset of this disease. Soon, a clear and very small vesicle or 
blister, appears on these red spots. Very soon, perhaps the 
same day, the vesicles burst, and a greyish yellow ulcer, of 
intense tenderness remains. Before the bursting of the blis- 
ters, there is very little pain or uneasiness manifested by the 
patient ; but, immediately afterwards, the smarting and pain 



INFLAMMATION OF THE MOUTH. 239 

become considerable. The slightest touch, becomes intol- 
erable, and, if it be in a child, it takes the breast with great 
reluctance ; I have seen many refuse it altogether, and never 
return to it any more. Taking food is also painful, especially 
if it is hard or dry. A grain of rice, or a particle of small 
hominy, lodging on one of these ulcers, is a cause of much 
pain, and the accidental occurrence of these spots, on the 
tongue or lips, where they are in contact with the teeth, 
produces constant irritation. So great is the irritation and pain, 
attending this disease, that the child who labors under it, is 
exceedingly troublesome, scarcely allowing rest to its nurse by 
day or night. I have often experienced attacks of* aphthae, 
brought on by a very slight dyspepsia. I can testify that the 
ulcers are exceedingly tender, and after being excited or touch- 
ed, give great pain. It is amusing to hear a French writer 
say, that in the worst form of this disease, a child manifested 
more pain from its crying than its tears. Screaming is the 
language of pain in young children — tears flow at a later age. 
In some cases the ulcers are very numerous, but very small, 
extending over the tongue and lining membrane of the mouth ; 
in others, they are very few, and proportionably larger. The 
eruption commonly appears all at once, and, if the number of 
points are increased, it is after a considerable time ; and, as it 
were, by a new eruption. The ulcers often increase in size, 
and several run together, forming larger ulcers ; but I never 
saw this so cover the tongue, as to produce a resemblance, 
to white thrush, nor have I seen any evidence that this dis- 
ease extends through the bowels, and appears at the anus. 
The excoriation and redness which I have seen on that 
part, have never been attended with an eruption, in the 
slightest degree resembling thrush ; and I have as often seen 
this excoriation, from acrid discharges, where there was no 
aphthae, as where there was. 

TREATMENT- 

We have stated that aphthae, or yellow thrush, is seldom, if 
ever, an original disease. It will be useless, in this place, to 
repeat the account of the remedies we have recommended for 
dyspepsia, diarrhoea or colera infantum, in which this dis- 
ease almost always occurs. If the patient labors under either 
of these diseases, the reader will please refer to them for his 
remedies. Should it occur during the progress of any other 
disease, he will, in like manner, refer to that ; but should it 



240 INFLAMMATION OF THE MOUTH. 

arise where there was no other evidence of ill health, it is here 
we should point out its proper remedies. 

Calomel, is so far superior to all other remedies, for this form 
of thrush, and for the diseased state of the stomach or intestines 
which gives rise to it, that I deem it scarcely necessary to men- 
tion any other internal remedy. To an infant one year old, it 
may be given in broken doses, combined with chalk as follows : 
Take of calomel four grains, prepared chalk thirty grains, rub 
well together, divide into four powders, and give one evening and 
morning. If they produce no bilious discharges, a dose of castor 
oil may be given, six hours after the last powder. This will rare- 
ly be necessary. These remedies may be repeated as often as 
the disease recurs, or, once a week, if it is not removed sooner. 
A salivation is little to be feared, and will never happen if the 
remedy passes off with bilious stools, or the castor oil is made 
to operate moderately well. It would be incredible to say, 
what proportion of patients with yellow thrush, I have dis- 
charged cured, with a single prescription of four powders of 
calomel combined with chalk. If the patient is more than 
a year old, the doses he takes should be proportionably in- 
creased. 

But it is far from being always necessary to give internal 
remedies for aphthae. I should not advise any remedy of a 
general nature, unless there was present an obvious general 
disease. I have a hundred times, seen aphthous ulcerations 
connected with indigestion, requiring no remedy but a proper 
regimen. But there is no case so slight, as not to justify, or 
require the use of local remedies. Even cases which would 
within a week get well of themselves, are too painful to be en- 
dured so long, when there is a remedy at hand. 

Lunar caustic, as a local remedy, is entitled to the same pre- 
eminence, as calomel as a general one. At the moment of 
its application, it may cause pain ; but this pain is transient, 
and the relief perfectly astonishing. I have had ulcers of this 
kind effectually touched with caustic ; and, in half an hour, 
the tenderness and pain disappeared entirely, to return no 
more. The same fact has been often verified by others ; and 
even in young children, I have seen the same good effect from 
it. The application is made by dissolving ten grains of lunar 
caustic in half an ounce of water, or distilled water if to 
be had — and applying it to the ulcers with a camel-hair 
pencil, or bit of fine rag or sponge, tied to a straw. If the 
aphthae are very numerous, and the application difficult, 
it may be well to make it to a part only of the ulcers at 



INFLAMMATION OF THE MOUTH. 241 

one time. But this precaution is seldom necessary — the child 
will cease, after a lew minutes, to complain of pain ; and 
it maybe dismissed after applying a fine rag to the surface, 
cauterised for a moment, to absorb that portion of the caustic 
which might otherwise discolor the teeth. Another, and per- 
haps abetter mode of applying lunar caustic, is in substance. 
Fix a piece of caustic in a quill as a slate pencil might be fix- 
ed, and be sure it is not so loose as to drop out in using it, and 
apply this freely to each ulcer. Touch the end to a drop of 
water before using it. In whichever of these modes this ap- 
plication is made, it is entirely safe ; and, so far as I have seen, 
far more effectual than any other remedy. The application 
may be made, once in two days, and is seldom required more 
than twice. 

I should feel perfectly satisfied to dismiss this subject here ; 
but there are remedies, less effectual, it is true, but more con- 
genial with the taste or feelings of some persons, and which 
will, in most cases, effect a cure. A mild cathartic of rhubarb 
and magnesia may be substituted for calomel. Take of rhu- 
barb ten grains, calcined magnesia, twenty grains, mix and di- 
vide into four powders. Give one every three hours, in syrup 
or water, till they operate. A dose of castor oil may an- 
swer as good a purpose. 

Milder local applications may also be tried in the first in- 
stance. Borax, in fine powder, mixed in syrup or honey, is 
one of the best. Alum, used in the same way, is more power- 
ful, but far more painful. This last circumstance renders it 
proper to dissolve the alum in water, twenty grains to the 
ounce, and apply it in the manner above directed for the caus- 
tic. A solution of surgar of lead, of the same strength, and 
used in the same way, will be far less painful, and perhaps 
equally effectual. Vegetable astringents, in endless variety 
are always at hand, and may be used without fear. A strong 
infusion of galls, or of persimmon, or oak bark, may be tried. 

Thrush, as we have described it in this article, is a mild dis- 
ease, never, as I think, becoming dangerous, except from its 
complication with disorders of the stomach and bowels. It is, 
theref>re, to be treated in reference to these disorders. If, 
therefore, this eruption of the mouth takes place, the general 
health of the patient is the first subject of investigation. And 
if the disease which may have produced the aphthae, is obvi- 
ous, that disease is the most important object of our attention. 

16 



242 INFLAMMATION OF THE MOUTH. 

ULCERATION OF THE MOUTH. 

T have never seen the false membrane which is said, in some 
cases, to form over ulcerations of the mouth. But an ulcera- 
tion, commencing in the gums, and sometimes extending to the 
inside of the cheeks, is not a very uncommon disorder. In 
some cases, it becomes formidable, producing sloughing of 
the gums, and exfoliation of the alveolar process, or part of 
the jaw bone in which the roots of the teeth are fixed. This 
is the canker of some writers. I have seen portions of the 
bone containing the first, and the rudiments of the second teeth, 
exfoliate in this manner, but never knew the jaw bones to sus- 
tain any further injury from this disease. In milder cases, the 
gums are found to leave the teeth, partly by erosion, and part- 
ly by a swelling which seems to turn out the gum, and leave 
the teeth with little support. They are loose, and disposed to 
fall out, the breath is offensive in the extreme, and the health 
destroyed. There is less fever than in other diseases of the 
mouth, and in the few cases I have seen, the skin was cold, 
the pulse small, and the complexion pallid or rather marbled- 
as in scurvy. I have witnessed such cases only in the hum- 
blest walks of life, and have suspected improper food as the 
chief cause. 

TREATMENT. 

The general remedies are such, as nourish the body and in- 
vigorate the system. For a day or two, on first giving reme- 
dies, I think there is nothing equal to sulphate of quinine. To 
a child six years old, give five grains, divided into six doses, 
in the course of the day. Elixir of vitriol — diluted sulphuric 
acid — may be given in doses of five or six drops, three times a 
day. It may be given at the same time with the quinine, or 
afterwards. Spirit in small quantities, or vegetable tonics, or 
bitters, may be given, according to the debility of the patient. 

The local applications should be stimulant and detergent, 
rather than caustic. Tincture of myrrh, diluted with four 
times its measure of water, is perhaps the best. Tincture of 
bark may be used in the same quantity. These remedies 
may be applied with a camel-hair pencil, or some similar im- 
plement. If the ulceration is extensive, lint should be laid on 
the ulcers before applying the medicine. 

Food. But the most important means at our service, in these 
cases, is rich and proper food. If the patient has been poorly 
fed, let a gradual provision of better food be made. If there 






INFLAMMATION OF THE MOUTH. 243 

is reason to suspect scurvy? let vegetable acids, especially 
lime juice, be liberally given. Care should be taken to avoid 
giving food that does not agree with the stomach. Perfect di- 
gestion is to be obtained, if possible ; and if food too rich and 
feverish is first tried, it can be abandoned for that which is 
lighter. 

GANGRENOUS SORE MOUTH. 

This is a more violent and probably altogether differ- 
ent disease from the foregoing. It is true, the ulceration we 
have been describing, sometimes becomes gangrenous, and 
produces sloughing, exfoliation and death; but the disease 
we are about to describe, makes its attack more suddenly, and 
is more rapid in its progress. 

The cheek is attacked with pain, and, on examination, a 
hard tumor is found. This may occur during the progress of 
fever, dysentery, or ulceration of the mouth; but I believe it 
has as often occurred when there was no other disease ex- 
isting. The pain is violent, and the swelling rapidly increases. 
In a day or less, the cheek assumes a crimson redness ; and 
about the centre of this redness a bluish spot is seen. By this 
time a gangrenous erosion has happened on the inside of the 
cheek. This is a true mortification, and rapidly spreads. The 
patient becomes feverish, exceedingly restless and delirious, 
and death probably closes the scene in four or five days. Some 
cases reserve a fate a little better for the sufferer — it is not 
death. The mortification stops, and a sloughing of the cheek 
more or less extensive, takes place. The patient recovers, 
but with great loss of substance, and great deformity. I have 
seen a case in which the disease commenced near the corner of 
the mouth, and, in eight or nine days, had entirely encircled the 
mouth. The lips were wholly destroyed. The patient recov- 
ered ; but so strong was the contraction from cicatrization, that 
his jaws were so clenched that a knife-blade could not be forc- 
ed between the teeth. He was reduced to the necessity of 
sucking through his teeth, the food on which he barely subsist- 
ed. In this state he returned to me, after an absence of three 
months from the time he had been cured of the mortification. 
There was no choice between an operation and starvation. I 
had experienced the proneness of cicatrices to reunite, and ren- 
der operations useless, and proceeded accordingly. I cut free- 
ly from each corner to the masseter muscle on each side, giv- 
ing him a mouth by four inches wider than that he was born 



244 INFLAMMATION OF THE MOUTH. 

with. He is now so far as I know in good health. This case 
occurred in a healthy man in the meridian of life. 

TREATMENT. 

I have treated two cases of this disease — one occurred dur- 
ing an attack of dysentery, and the other to a man in ordinary 
health —the one with dysentery died — the other recovered as 
above stated. Both were treated on the same principles. 

An account of the successful case will sufficiently show nry 
mode of treatment. The mortification had fully disclosed it- 
self when I first saw it — my patient was in great pain, and I 
gave him three grains of opium, in a pill. At the same time I 
directed sulphate of quinine, at the rate of twenty grains in 
twenty-four hours. 1 directed warm applications to the mouth, 
but it was difficult to use them efficiently. The opium seemed 
to have but little effect, and was gradually increased, so that, 
in the course of three or four days he was taking, about ten 
grains of opium, each twenty-four hours. Sloughing com- 
menced in about six days ; during which time he had taken 
the quinine, at the rate of twenty grains daily, and the opium 
in gradually increased doses, as above stated. Tincture of 
myrrh to the sloughing surface, was now added to his remedies; 
he seemed better ; but, at one point, the mortification had not 
commenced sloughing. Contrary to advice, he was now taken 
to his residence at a distance of twenty miles ; and in eight 
days was brought back, extremely ill, with the mortification 
extended quite around his mouth. His remedies were now re- 
newed, and, in addition to them, he took freely of distilled 
spirit. The mortification ceased to spread, and a sloughing, 
which I thought very imperfect, began. The line between the 
HiortiGed and living flesh seemed illy defined. I applied a 
strong solution of lunar caustic daily. The case now changed 
rapidly for the better ; and, in about three weeks from his second 
treatment, he was dismissed. The damage sustained by this 
poor man was very great, and may signify, that the treatment 
might be much improved. But it is to be remembered, that he 
had a very imperfect trial of his remedies, from not being early 
enough under their operation ; and again, from their being im- 
properly suspended, before the case had terminated. I should 
not despair of better success with the same remedies, if ap- 
plied in due time, as above directed. 



245 



CLERGYMAN'S SORE THROAT— CHRONIC 
LARYNGITIS. 

The variety of disorders which attack the breathing appa- 
ratus, is so great, that there is constant danger of mistaking 
one for another. Almost all these disorders rest on inflamma- 
tion ; but the manner in which, in particular instances, it con- 
fines itself within a very narrow limit, is remarkable. The 
larynx, as we have seen, is subject to various kinds of acute 
inflammation; we are now to consider it, when inflamed, or 
ulcerated, in a chronic form. From the frequency with which 
it attacks persons who follow public speaking, it has acquired 
the common name of clergyman's sore throat ; and there are 
many instances, in which it drives from the pulpit, those who 
had devoted their lives to its dangerous labors. 

The causes of this disease are, many times, not to be dis- 
tinguished from those producing common colds. But as the 
inflammation attending it, is near the seat of the voice, it is ob- 
vious that the powerful effort of the orator is calculated to ag- 
gravate its symptoms. 

The consequences of this inflammation, are more grave than 
might at first be expected. The inflammatiou being chronic, 
results in the production of small ulcers, or pustules, which are 
found sometimes in considerable numbers, in the back part of 
the throat, and probably farther down than they can be seen. 
Sometimes this ulceration becomes considerable, injuring the 
epiglottis, and destroying the voice. The health becomes ve- 
ry much deranged, and, in many instances, consumption fol- 
lows. 

The symptoms by which this disease is known, are, in the 
first place, a remarkable degree of hoarseness, with some un- 
easiness about the throat, and a general appearance of great 
debility and ill health. The pain will commonly be referred 
by the patient to a particular spot, with a particular sense of 
pricking or tickling. This tickling produces more or less 
cough, but at first without any expectoration. As the disease 
progresses, the throat becomes sore, the swallowing painful — 
in some cases strangling or suffocation attends the attempt to 
swallow fluids. On examination, by placing the patient in a 
fair light, and pressing down the tongue with the handle of a 
spoon, a part of the diseased organs may be readily exposed. 
Sometimes small pustules with white tops, may be seen in the 



246 

back part of the throat ; in other cases, deep redness with 
points apparently raw, and secreting matter, spread over the 
entire region that can be seen beyond the palate ; in other and 
worse cases, deep ulceration is seen, on one or both sides. 

No disease is more formidable than this, when it proceeds to 
a certain extent ; the voice is almost, or entirely lost ; hectic 
fever, great wasting of the flesh, and copious expectoration, 
signify but too clearly the fatal result which may be appre- 
hended. 

Great obscurity hangs around the causes of this disease. In 
some instances, it is exceedingly rapid in its progress, termi- 
nating fatally in a few months ; while, in other cases, it may- 
last for many years. Sometimes it seems to have been indu- 
ced by the protracted use of mercury ; sometimes it has ap- 
peared to arise from typhus fever. Indeed the causes assign- 
ed for it, are so various and inconsistent, that we are often led 
to suppose, that it occurs spontaneously, and without any de- 
pendence on these causes. 

TREATMENT. 

In its first stage, this disease may not differ very widely 
from a common cold ; the inflammation occupies pretty much 
the same seat, and will require but the light treatment recom- 
mended in that disease. But when the disease is found to 
continue without abatement, when the hoarseness proves ob- 
stinate, and, on examination, the diseased appearances de- 
scribed are seen in the throat, we are to consider ourselves as 
engaged in treating a serious disorder. Every exciting cause 
should be forborne ; loud speaking should especially be for- 
bidden ; and, where the disease in the throat is obviously bad, 
it is not too much to require positive silence from the patient ; 
he should by all means be told, that whispering is abundantly 
more safe to him than loud speaking. Other causes of excite- 
ment should be equally avoided; fatigue or exposure to cold, 
and all the causes of inflammation in general, should be care- 
fully shunned. 

But it is not from abstinence alone that we are to expect a 
cure in chronic inflammation of the larynx ; remedies of the 
most active character are necessary. Bloodletting should not 
be neglected, unless the debility of the patient, and feebleness 
of the pulse, should seem to forbid it. Leeches applied to the 
throat, or cupping on the back of the neck, are remedies of the 
same character, and entitled to their place in the treatment. 



247 

Tartar emetic is a valuable remedy in this disease; it should 
be given in such doses, as the stomach will bear, without ex- 
citing vomiting — from a quarter of a grain to half a grain, two 
or three times a day. It is best taken at times as distant from 
taking food, as can be conveniently chosen. This remedy is 
especially called for, at an early stage in the disease, and is to 
be used with a perseverance corresponding with the severity 
of its symptoms, and the strength of the patient. 

Counter irritants such as blisters, sinapisms, and issues, 
are to be called into requisition, under various circumstances, 
in protracted cases. From blisters applied to the throat or to 
the back of the neck, I have seen the greatest advantage de- 
rived. If the discharge of blistering is not desired, a beneficial 
influence will be exerted by the application of sinapisms in 
their stead. Issues are suited to protracted cases. They 
should be made on the back of the neck, by means of caustic, 
or the introduction of a seton. 

Opinions are divided on the use of mercury ; my own opin- 
ion is decidedly in its favor. But it should not be used in such 
quantit} r , as to excite much salivation. The remedy which I 
have used with more benefit than any other, is the following: 
Take of calomel ten grains, tartar emetic six grains, opium 
twelve grains, mix together, and divide into twenty-four pills. 
Of these pills, two may be taken daily, one at bed time, and 
the other at nine o'clock in the morning. They may be con- 
tinued for many days, or indeed for many weeks ; it being 
only necessary to observe, that the patient is not thrown into 
any considerable degree of salivation. The composition of 
these pills may be changed to suit the case under treatment. 
The quantity of tartar emetic maybe increased, if it produces 
no obvious effect on the stomach ; the quantity of opium may 
be doubled, with great advantage, where the patient is much 
exhausted, and great irritation is present; and the same re- 
mark may be made with regard to the calomel, which may 
be modified in quantity or wholly omitted, according to the 
discretion of the practitioner. This combination of remedies 
is not to be abandoned lightly, for it will be seldom substituted 
by a better. 

It should be borne in mind, that this disease sometimes ari- 
ses from a venerial, or syphilitic teint. ' This cause is to be 
suspected in many instances, in which the patient will have 
no suspicion that he is affected with any such disease. I can 
offer no particular rules for the limitation or adoption of this 
belief, in any particular case ; but, it may be observed in gen- 



248 clergyman's sore throat. 

eral, that there is no disease which seems to continue so long 
in the constitution, or to be transmitted from one person to an- 
other under circumstances more obscure than syphilis. The 
suspicion in these cases can but direct to a more diligent atten- 
tion to the use of mercury. This remedy is, in my opinion, 
proper in almost all cases, and it would be exceedingly unfortu- 
nate if a person should be suffered to die for not having used 
it, where it is the only remedy to be relied on. Nor am I so 
ready to credit the statements which have been made of the 
injurious effects of mercur}', in this disease. 1 am decidedly 
in favor of making trial of its influence in almost every case, 
in which the patient's strength is not already too much ex- 
hausted. 

In some instances, this disease is attended with a copious 
discharge of pus from the lungs. It would be taken in these 
cases for tubercular consumption, if the history of its rise and 
progress were not attended to. The advantage of this scru- 
tiny, is the reasonable ground of hope it gives of the recovery 
of the patient, from symptoms so alarming. In these cases, 
balsams have been found particularly beneficial. Twenty 
drops of balsam copaiva may be taken on sugar, three or four 
times a day ; if it produces nausea, or operates upon the bow- 
els, the dose may be lessened. The remedies advised in this 
disease, should be used in such moderation, as will admit of 
their being continued for a considerable length of time. This 
is especially the case with blistering, issues, and caustics. 
The discharges brought on by their application to the skin, 
should be kept up for a considerable length of time. Nor is 
the local treatment of the disorder in the throat to be less re- 
garded, or adhered to with less constancy. The pustules, or 
abraded and raw surface seen in the throat, are to be treated 
with the application of caustics, from time to time. Take of 
lunar caustic, forty grains, dissolve it in an ounce of water. 
Apply this by means of a camel's hair pencil or small mop, to 
the ulceration in the back of the throat. Where it is obvious 
that the ulceration extends down beyond the points to which 
our investigation can extend, means may be used to extend the 
caustic application lower. A piece of whalebone, or tough 
wood, eight or nine inches in length, may be used for this pur- 
pose. A small piece of sponge, the size of the end of the little 
finger, or a rag of similar dimensions, may be securely fasten- 
ed to the end of this instrument, dipped into the caustic solu- 
tion, forced a few inches down the throat, and withdrawn. 
This mode of applying caustic is perfectly safe, and requires 






DISEASES OF THE LUNGS. 249 

only the precaution of not having the sponge when used, filled 
with so much of the fluid as to cause a great deal to flow out 
of it. 

The slow progress of this disease gives time for the advan- 
tages of change of climate, and all the benefits which a change 
of regimen will produce. Great benefit has, in many instan- 
ces, been derived from a change, especially from a colder to 
a warmer climate ; and this remedy is here particularly sug- 
gested as affording more hope in this, than in most other forms 
of the disorders of the lungs, and connected organs. 

We have said but little of the regimen which should be used 
by patients in this disease. During its earlier stages, the food 
taken should be of the least stimulating, and the blandest kinds ; 
but this stage of the disease soon passes by, and it becomes de- 
sirable to afford our patients a regimen, sustaining and nutri- 
tious, if not rich. At the same time, it should not be forgot- 
ten that the stomach is apt, in these cases, to be weakened in 
its digestive powers. Alkalies or other absorbents should be 
habitually used by those afflicted with this disease. Twenty 
or thirty grains of prepared chalk may be taken, after break- 
fast, and after dinner. If the bowels are costive, an equal 
quantity of calcined magnesia, may be taken in its place. 
These, and other similar remedies, may be used at any time, 
in the course of the disease. 



DISEASES OF THE LUNGS. 

AUSCULTATION. 

It would be considered unpaixlonable in this day of inves- 
tigating diseases through the medium of hearing, to give an 
account of the diseases of the lungs, without saying something 
of this mode of investigating their characters. But it is as 
well to acknowledge the truth — I know but little of ausculta- 
tion ; and confess that my faith in the utility of this mode of in- 
vestigation, is not very strong. Nor do I feel authorized to be- 
lieve, that any very great advantage in the mode of treating 
diseases, has resulted from what has been termed the great dis- 
covery of Laenec. I have, as in duty bound, read two or three 
long chapters filled with high praises of auscultation ; and while 
admiring the certainty with which the particular seats of dis- 
ease by this new mode of investigation, were said to be pointed 



250 DISEASES OF THE LUNGS. 

out, my hopes were suddenly cut down by reading at the bot- 
tom of one of these chapters; that " physical diagnoses had. 
not certainly revealed or suggested, any new remedy or new 
plan of treatment generally." To this humiliating conclusion 
have those who have studied and practiced auscultation, ar- 
rived at last. 

I do not pretend to teach the mode of investigating disease 
by auscultation. That it rpay, in a few instances, be useful, I 
shall not deny ; but that its imperfections at best, are very 
great, and that without constant practice and the diligent com- 
parison of one case with another, it is calculated to mislead, I 
fully believe. I have no doubt that in cases of great destruc- 
tion, or of cavities formed in the lungs, and in certain diseases 
of the heart, some degree of knowledge may be obtained in 
this way. The patient may have through this means his last 
ray of hope destroyed, but what is gained in the mode of treat- 
ing his disorder ? 

It would be wrong for a young physician to neglect the in- 
vestigation of disease by this means. Auscultation is a field of 
promise ; its results have been unexpected and remarkable, 
and the usefulness that may yet be found to arise from it, can- 
not be foreseen. In a limited way, investigations have been 
made in this manner from the earliest times ; a slight blow with 
the hand will, many times, yield a sound very significant of 
the nature of the matters contained within the part. Over the 
lungs such a means of investigation will often detect the pres- 
ence of fluid, or its absence. The sound yielded will be sig- 
nificant of air, or a denser fluid. Heavy fluids contained in 
the natural cavities, are sometimes heard to descend to a lower 
point, when the patient has changed his position. This I have 
witnessed in dropsy of the lungs, in which, if the patient turns 
from one side to the other, the water may be plainly heard 
trickling down to the part which has now become the lowest. 
The subject may be considered new. It is undergoing daily, 
an intense investigation, and I can but hope its results will 
prove as beneficial, as its most zealous votaries can desire. 

INFLAMMATION OF THE LARYNX. 

The larynx is the upper orifice of the wind-pipe, through 
which, in the process'of breathing, air enters the lungs. It is 
frequently the seat of disease, and is the principal seat of what 
is termed a common cold. It occurs under various circum- 
stances, and sometimes seems to have but little tendency to 
descend to the lungs. 



COLD OR CATARRH. 251 

In its simplest form, inflammation of the larynx is not at- 
tended with much cough ; there is, however a considerable 
hoarseness attended with some cough, although not to a distres- 
sing degree. Its attack is sometimes preceded with heaviness, 
languor, and a low degree of fever. Pain in the larynx, es- 
pecially in attempting to swallow any thing, is also a trouble- 
some symptom. In some cases the disorder seems to be 
brought on by a low degree of inflammation, occurring in the 
roof, or the back part of the mouth, and extending to the 
larynx. The disease, in this form, is seldom formidable. 

The remedies used in this disease, are those common for in- 
flammation generally ; but there are some which are pecu- 
liar to this disease, in consequence of its particular locality. 
Bloodletting and a cathartic of calomel should be used, if the 
pain is considerable, and especially if it is attended with much 
swelling. Leeching of the part may also be mentioned as a 
proper remedy. Mucilaginous drinks, such as flax seed tea or 
a weak solution of gum Arabic, taken warm, have been also 
recommended. These remedies are, in my view, of but little 
consequence ; and where the disease is slight, and attended 
with but little pain, I usually satisfy myself with giving a dose 
of calomel, and advising abstinence and rest. 



COLD OR CATARRH. 

Every one knows a common cold ; and there are few who 
would not tell you, that it is a disease attacking principally the 
lining membranes of the nostrils, producing frequent sneezing, 
watery eyes, cold extremities, with more or less chilliness. To 
these symptoms we may add one less frequently noticed, the 
copious discharge of limpid urine. Some degree of fever 
and cough, with pains in the limbs, heaviness, and oppression, 
complete the symptoms by which a common cold will be known 
from almost every other disease. It is true, these symptoms 
occur in the onset of several diseases ; measles is, on the first 
day, scarcely distinguishable from a common cold ; and I have 
seen the same statement apply in small-pox, and in bilious fe- 
ver. Still, the common cold will be known from other disor- 
ders in the course of a short time ; for be} r ond a cough and low 
degree of fever, its symptoms seldom progress. 

Exposure to cold being frequently followed by the symptoms 
we have described, has given name to the disease under con- 



252 COLD OR CATARRH. 

sideration. But there are other causes, or at least another 
cause, much more frequently concerned in the production of 
this disease, than might be at first supposed. Without regard 
to changes in the atmosphere, common colds are often epi- 
demic, attacking many persons at the same time, in the same 
manner. Influenza which resembles it so closely as to be 
scarcely discriminated, prevails over vast tracts of country, re- 
gardless alike of summer and winter, heat and cold, wet and 
dry. In the same manner I have observed common colds to 
prevail ; and I have thought that they were apt to be worse, 
when occurring in warm weather. 

REMEDIES. 

So slight is this disease, in a majority of cases, that patients 
will scarcely demand a remedy. Individuals differ very much 
in the manner in which they are affected ; some being scarce- 
ly affected with any cough, while others are affected with a 
violent cough, almost from the first. When the cough is very 
slight, and the fever considerable, a cathartic of ten grains of 
calomel should be given. If it does not operate in six hours, 
give half an ounce of Epsom salts, or a seidlitz powder. The 
patient should abstain from food, or take that which is exceed- 
ingly light, and, without further remedy, the disease will dis- 
appear in a few days. 

When the disease descends to the lungs, and the cough be- 
comes considerable, antimonial mixture is the best remedy. 
Take two grains of tartar emetic, and one drachm of nitre, 
dissolve in half a pint of water, and give a table spoonful once 
in three or four hours. If it operates as an emetic, reduce the 
dose to one half, or even less ; but the remedy should not be 
dispensed with, till the cough is greatly alleviated, or a free 
discharge of mucus from the lungs, is brought on. In worse 
cases where the fever is high, the cough incessant, with more 
or less pain in the breast and head, the remedy should be giv- 
en in a more decided way. In these cases, a table spoonful 
may be given, every half hour, till a full emetic effect is pro- 
duced. 

Should the cough continue troublesome after a day or two, 
the antimonial mixture should be continued, in greatly reduced 
doses. A tea spoonful, three or four times a clay, will proba- 
bly be sufficient. When the cough is very troublesome at 
night, and the remedies we have spoken of, have been admin- 
istered for two or three days, the patient should take, on going 



COLD OR CATARRH. "25 o 

to bed, a full dose of antimonial mixture, with thirty drops of 
laudanum. This is an exceedingly valuable combination of 
remedies, and may be repeated, from night to night, as long as 
the symptoms require it. 

Alkalies have been extolled in the treatment of protracted 
cases of hooping cough ; and I have found them, as I think, 
a great deal more valuable in the treatment of common colds. 
When the cough proves obstinate, and the fever is protracted, 
the digestive powers are very much impaired, although the 
appetite for food continues. It is in these cases, and they form 
almost every case of cough which lasts for two weeks, I advise 
the following prescription. Take half an ounce of carbonate 
of soda, dissolve it in a gill of cold water, and give two tea 
spoonsful, three times a day, after meals. The dose may, 
without inconvenience, be doubled, where, from the symptoms, 
much disorder of the stomach is found to be present. Where the 
soda is not at hand, the common preparation of potash or sal- 
aeratus, may be substituted, and used in the same manner and 
quantity. This remedy may be used at any time in the pro- 
gress of the disorder. It is least called for in the first stage, 
when the patient is usually restricted to low diet; but when the 
appetite is good and much food taken, this mode of using al- 
kalies will be found very beneficial. It is surprising to witness 
the sudden cessation of the most distressing cough, from a few 
grains of soda given in this way. 

There has somehow, got into the world a very mischievous 
proverb, "starve a fever, and feed a cold." That part of this 
old saw, which prescribes food for a cold, has done more than 
a little harm. Almost every cold that requires the use of any 
remedy, is attended with an inflammatory fever which requires 
anything rather than food. The true rule is, to regard this fe- 
ver as the criterion by which to prescribe in the disease ; and, 
while its symptoms continue inflammatory, the regimen ought 
to be proportionably low. For the first week, the person who 
is attacked with a severe cold, ought to forbear the use of ani- 
mal food, and even live on a restricted amount of lighter arti- 
cles. It is not the continuance of the cough, but of the fever, 
which forbids the use of nutricious food. But the cough is very 
often kept up by the stimulating effects of hearty food ; for pa- 
tients, in this disease, are generally not so sick, as to consider 
themselves under the necessity of obeying very close restric- 
tions in diet. 



254 croup. 



CROUP. 



The rage for coining names has been played, on this formi- 
dable disease, to less injury than that of most others. It is 
known by the same name in England, and on the continent of 
Europe, as well as in the United States. And it can hardly be 
said|that its technical cognomen, is as well understood even in 
the halls of science, as the common name of croup. It is said 
that in some parts of the United States, the disease is known 
by the appellation of hives ; but I am persuaded that this term 
is no where extensively used ; and the term croup brings to 
the mind a vivid idea of the same disease, in all parts of the 
country. 

Inflammation of the mucous membrane of the larynx, ex- 
tending down the w r ind pipe towards the lungs, constitutes 
croup. This inflammation is of the kind which throws out on 
the surface the albuminous portion of the blood, forming a 
coating which sometimes, in protracted cases, becomes a mem- 
brane and is separated ; very much resembling the finger of a 
glove, formed of some very fine skin. The symptoms of croup 
are, nevertheless, present, previous to the formation of this 
membrane; and, in many instances, death occurs without any 
formation of the kind taking place. 

Croup, many times, takes place in complication with exten- 
sive inflammation of the lungs. It is a disease of childhood ; 
and, in these cases, the child may be said to labor under pneu- 
monia, or pleurisy, and croup at the same time. 

CAUSES. 

We have said that childhood is the age of croup ; and this 
is manifest from its appearing almost exclusively in children 
before the age of puberty. It arises from those causes which 
produce a common cold; and of these, exposure to dampness, 
and great changes in the temperature of the atmosphere, are 
the chief. But the disease is sometimes epidemic, occurring, 
in many cases, about the same time, without any obvious state 
of the atmosphere to account for it. And it has been observ- 
ed, in other instances, to take up, as it were, a local habitation, 
producing many cases in one part of a city, while the children 
inhabiting the other parts, were entirely free from it attacks. 
Since I have been an observer of diseases, the croup has pas- 



citour. 255 

sed through a considerable change in the district of my obser- 
vation. About thirty 3 r ears ago there were many cases, and 
this continued for several years; the disease has since declined 
in its frequency, so that I now seldom meet with it. This dif- 
ference in frequency is too great to have been overlooked. 
The cases in which I was in the habit of meeting with it, in 
those j^ears, in the course of one winter, were at least ten 
times as numerous, as they have been for the last five years. 

DESCRIPTION. 

Croup, in its mildest form, has great resemblance to a com- 
mon cold. The attack occurs with hoarseness, cough, and 
some fever, frequently with vomiting, which discloses a state 
of acidity of the stomach, and great derangement in digestion. 
The cough and hoarseness are peculiar, producing a sharpness 
in the voice not common to the patient. In the majority of 
formidable attacks, the disease comes on suddenly, after the 
child has been some hours asleep. The parents and nurses 
are aroused by the dreadful sound of croupy cough. This 
sound, when once heard, will not be easily mistaken. It has 
been compared to many noises, the barking of a little puppy will 
probably furnish as good an idea of it, as I can give. The 
child will commonly sit up in its bed, and, on examination, it 
will be found to breathe with some difficulty. Its respirations 
will be slow, with considerable noise or hissing. The cough, 
though not incessant, will be very frequent ; and, in a short 
time, the face will be flushed, the eye tearful, and the counte- 
nance peculiarly anxious, and distressed. As the disease pro- 
gresses, the pulse becomes hard and quick, the thirst great, and 
the skin dry, the urine scant and deep colored, and the eyes swol- 
len or blood shotten. The anxiety and restlessness which now 
come on are extreme. The breathing, though not very fre- 
quent, is sudden ; and, at each effort to breathe, a sudden pit- 
ting is observed at the pit of the stomach, and at the bottom of 
the neck. Ihe skin becomes mottled, the nails purple, and, if 
not arrested by efficient remedies, the case terminates fatally, 
in from one to two days. 

In many instances, the disease seems to give way to the first 
remedy used ; an emetic probably seems to put a period to it 
in a few hours ; but such recoveries are to be looked on with- 
out much confidence, for the patient is too often attacked again, 
in the same manner, the next night ; and then the case is apt to 
be more formidable. 



256 croup. 

Croup is not always so violent and acute a disorder as we 
have described. It is sometimes much slower in its progress, 
and lasts from a few days to two or three weeks. These cases 
are scarcely less dangerous than the most acute. The sound 
of the cough will be very much the same with the acute dis- 
ease ; but it returns much less frequently. The child will, 
many times, seem to be free from any pain, and play about the 
house without complaint; still it has fever, with considerable 
rapidity and hardness of pulse, with the characteristic rough, 
hissing sound in its breathing. In this manner the case, if not 
arrested, will gradually grow worse, from day to day; and the 
termination will be with symptoms very like those we have 
described above. 

This disease does not always terminate when its symptoms 
are relieved, but often becomes protracted into a sort of second 
stage. The characteriotic breathing and rapid pulse will con- 
tinue, but with a great degree of mitigation. The secretions 
of the lungs begin to be more abundant, but are yet exceeding- 
ly tough, so that they are coughed up with great difficulty. 
Every movement of the chest appears at length to become 
painful; the breathing becomes a low sort of wheezing; and 
if the patient desires to speak, it is done in a low, whispering 
voice. The tongue becomes loaded with fur, stools dark and 
fetid, hands and feet swollen and cold, and death too often fol- 
lows, when during a great part of the disease the symptoms 
had not appeared to be formidable. 

In some cases, the patient seems to be borne out by the 
powers of nature, through every difficulty. The discharge of 
mucus and pus by coughing, becomes very considerable; and, 
in some instances, a large portion of membrane is coughed up, 
and safely discharged ; but this is done through imminent 
danger of suffocation and death. Slow recoveries sometimes 
happen after this dreadful extremity. 

Croup has appeared under so many circumstances, and com- 
plicated with so many disorders, that writers seem to have 
fatigued themselves with their narration. I have met with only 
one of these on which I think it necessary to make a few re- 
marks. I have, in teething children, met with croup that 
seemed to rest entirely on a disordered stomach, always oc- 
curring after over-eating of indigestible food. These cases are 
quickly relieved by an emetic, and require nothing peculiar in 
their treatment, except a diligent regard to proper food. 






croup. 257 

treatment. 

The attack of croup is always regarded as formidable; and 
the influence of the hurry and confusion which takes place in 
families in which it occurs, should be guarded against by the 
physician. He should investigate the case with sufficient 
calmness, and especially ascertain all the remedies which have 
been used. 

The first, and most valuable remedy in this disease, is tartar 
emetic ; and it is to be given in doses far beyond what would 
seem proper to a patient of the same size and age, in another 
disease. I combine the remedy with nitre, believing that in 
this combination, it is a more efficient and powerful remedy. 
For a child six years old, take six grains of tartar emetic, and 
two drachms of nitre, and dissolve together in half a pint of 
water. A tea spoonful of this mixture may be given every 
half hour, till it operates as an emetic. If the tea spoon is 
large, the first dose may be made rather small, but if this dose 
produces no effect in half an hour, the second may be given 
without any abatement ; for, in this disease, the stomach often 
bears an incredible amount of this remedy. I have given the 
whole of such a mixture as I have described, containing six 
grains of tartar emetic, to a child of four years old, in less 
than twelve hours. This amount should only be given in the 
presence of a physician, but in the event that this responsi- 
bility is obliged to be taken by others, I may remark that the 
medicine is to be made to operate as an emetic at almost any 
hazard ; for it is through this action, that relief is to be ex- 
pected. 

If the emetic fails to operate, on giving a second or third 
dose, the child should, if possible, be induced to drink large 
quantities of tepid water. A few grains of ipecac will some- 
times bring on the emetic action, in a few minutes. Where the 
danger seems to be imminent, and the breathing very much 
impeded, vomiting may be brought on by forcing a feather 
down the throat. By these means the action of the stomach 
will commonly be brought on, within an hour or less. The 
patient is then to be carefully watched. If the stomach be- 
comes quiet, and the respiration becomes worse, with an increase 
of fever, the same remedy is again to be repeated, in the same 
manner. And thus the contest maintained till the disease is 
vanquished, or until the strength of the patient fails. In almost 
every case, relief, more or less perfect, will be obtained, by 
the action of the emetic. 
17 



25S croup. 

We are not allowed to restrict ourselves to the use of a sin- 
gle remedy, in this formidable disease. Many cases, it is true, 
will yield and finally disappear from the use of tartar emetic 
alone ; but patients in this disease are not always so fortunate. 
The relief obtained by the use of an emetic alone, is imper- 
fect ; and the disease is found to be gaining, rather than losing 
ground. In some cases, indeed, emetics seem to give but little 
relief. This, I am bound to state, because it is so stated, by 
eminent men who have seen the disease in higher latitudes, 
where it is much more common and dangerous than it is here. 
But, in my own hands, a decided operation of tartar emetic, 
has scarcely ever failed of producing a very decided improve- 
ment, if not total relief. But should this relief fail to take place, 
I concur fully in the recommendation of bloodletting, as the 
next best remedy. This operation is not always easily per- 
formed on children, and when it cannot be done, leeches may 
be substituted. Blood should be drawn in this case copious- 
ly ; four ounces have been advised for a child of two years old. 
This, I think, a very large quantity ; and I should not advise 
it, except the case appeared extreme. Cupping might be em- 
ployed in the neighborhood of the parts ; on the back of the 
neck for instance, or on the sternum. 

The state of the bowels is not to be disregarded, in this dis- 
ease. It is by no means desirable to produce, in a very early 
stage of the disease, copious watery discharges by the bowels. 
On the contrary, when such discharges occur from the use of 
tartar emetic, and that remedy fails to produce its usual emetic 
effect, the patient may well be considered in extreme danger. 
But where the emetic has operated favorably, it should be fol- 
lowed on the next day with a dose of calomel. Five or six 
grains may be given, in syrup, to a child of six years old. This 
will commonly operate, and need not be repeated, unless the 
case prove obstinate and protracted. In that case, it is recom- 
mended to give calomel, daily, two or three grains a day. I 
advise that this should be done only two or three days in suc- 
cession, unless it is followed by a decided and free operation 
by the bowels ; for, although salivation is not much to be ap- 
prehended in these cases, I think calomel is to be used with 
that watchfulness which the remedy requires, in children of 
tender age. 

Blisters I have used with striking and beneficial effects. 
After two days treatment, if the fever is considerably reduced, 
and the medicine has operated copiously, and the cough and 
other symptoms of the disease still remain ; a large blister 



croup. 259 

should be applied to the breast ; and suffered to remain until 
fully drawn. 

The practitioner is to meet croup without too much confi- 
dence in the power of his remedies. He is constantly to ap- 
prehend a fatal result, and be prepared for the worst. When 
the difficulty of breathing continues to increase, the face to be- 
come a little swollen, the eyes bloodshotten, and the countenance 
more distressed, warm bathing has been highly recommended. 
I have never used this remedy with much success ; for the pa- 
tients whom I have found in a state to demand its use, and in 
whom emetic treatment, had failed to arrest the disease, have 
sunk under the disease. Still I would use the warm bath, for 
I have no doubt it is sometimes successful, even in very bad 
cases. Jf warm bathing is used, a vessel large enough to ad- 
mit of covering the body of the child, should be used, and the 
water should be as warm as it can be well endured. The wa- 
ter should be about the warmth of blood, but should not be 
tested by merely feeling with the hand, for the water in which 
the hand may be easily held, might prove intolerably hot to 
other parts of the body. This suggestion is sufficient to enable 
anyone, with ordinary discretion, to avoid the error of using 
the water too hot. The bath should be continued till it pro- 
duces a degree of weakness, which may be observed by the at- 
tendants ; the child will become restless and strive to escape. 
Probably from fifteen to twenty minutes, is as long as it should 
be continued at one time. 

A great deal has been said on the use of sudorifics, or sweat- 
ing medicines, in obstinate cases of croup. To bring about 
perspiration, various remedies have been recommended ; the 
warm bath we have already spoken of, but steam and vapor 
baths have also been recommended. Of the internal reme- 
dies which produce perspiration, seneca snake root has had 
the most reputation. Dover's powder has also come in for its 
share of regard in these cases. Now I have not much faith in 
all or any of these means of exciting perspiration in croup. 
Where cases prove obstinate, and a copious discharge from the 
lungs is brought on by coughing, I can readily suppose that the 
use of opium, in the form of Dover's powder, would be ser- 
viceable. This remedy, and no other, do I reccommend to 
produce perspiration, in any stage of croup. Where the dis- 
ease has continued for a number of days, and the cough, with 
free expectoration, is still troublesome, take six grains of Do- 
ver's powder, and give it in a tea spoonful of water. This 
dose is sufficient for a child six years old ; and this remedy, 



260 INFLAMMATORY CATARRH. 

in larger or smaller doses, may be, from time to time, repeat- 
ed, till the distress, from cough and copious expectoration, 
has passed off. 



INFLAMMATORY CATARRH.— BRONCHITIS. 

I have not undertaken to reform the old, or establish a new 
system of medicine, and therefore will consider separately 
several disorders which might be more beneficially treated of 
together. Inflammatory catarrh runs so readily into pneumo- 
nia or pleurisy, has so many of the same symptoms, and re- 
quires so nearly the same treatment, that it may well be 
doubted whether its discussion should be made a separate 
article. Its technical name bronchitis, is also becoming al- 
most common language, and it would perhaps be on that 
account the more expected, that a particular and definite 
view of the subject should be given separately. 

The organs affected in bronchitis are the same as those af- 
fected in common cold. It consists in an inflammation of the 
mucous membrane, of the wind-pipe, extending down to the 
lungs. The inflammation is, however, not of the intense kind 
which prevails in croup, and the membrane throws out, not a 
tough albuminous matter, but a lighter mucus, which is 
thrown off by expectoration. No disease differs more in its 
degree in different cases. In some instances, the character of 
the inflammation seems to be mild, and free from danger; 
in others, it pervades very extensively the air tubes of the 
lungs, producing violent fever and great danger. 

Few diseases appear under more complications than this, 
It is very frequent in fevers of various kinds j measles, ty- 
phus fever, remitting fever, and even rheumatism, are frequent- 
ly attended with this particular affection of the lungs. — 
Influenza also very commonly produces it, and in many instan- 
ces, persons who are to all appearance attacked with a com- 
mon cold, run rapidly into an alarming disorder of this des- 
cription. 

The difference between this disease, common cold, and in- 
fluenza, are not always very easily seen. All these diseases 
may run into bronchitis, and are known to have done so only 
by the graver symptoms, and more alarming febrile state of 
the patient. 

Bronchitis is not always an inflammatory disease; and this 
forms the strongest reason for giving it a separate and particu- 



INFLAMMATORY CATARRH. 261 

lar consideration. Its symptoms have, under all circumstan- 
ces, very great resemblance; but they are not always to be 
treated with the active remedies for inflammatory disease. — 
On the contrary, there is sometimes present a debility and 
prostration, that requires a treatment exactly the reverse. It 
is our object particularly to point out these varieties, and as- 
sign to each its proper remedies. 

ACUTE INFLAMMATORY BRONCHITIS. 

This form of bronchitis comes on with coryza, or the wa- 
tery eyes and sneezing of a newly taken cold. Very soon, a 
pain and tightness across the breast is felt, attended with 
cough, and very often bloody expectoration; chills or a cer- 
tain shuddering in the midst of some fever, w r ith a very hot 
dry skin and quickened breathing, attend this early stage of 
the disease. As it progresses, the tongue becomes red, the 
pulse quick, full, and hard, with pain in the head, back, and 
limbs, and scanty, high-coloured urine. If the disease goes 
on increasing, for two or three days, the pain and soreness in 
the breast are greatly extended ; the cough is violent when 
excited by any change of position, or other slight cause, the 
patient lies particularly on his back; towards night the symp- 
toms increase, and a very great degree of restlessness is 
commonly experienced. 

If the disease is not promptly arrested in its progress, a 
rapid change in the state of the patient takes place ; great de- 
bility, feeble pulse, pale countenance, anxious and staring ex- 
pression, coated and brown tongue, with bloodshotten eyes, 
and delirium come on. This downward course is sometimes 
exceedingly rapid, producing death in a few days. 

The typhoid, or low chronic form of bronchitis, commences 
with symptoms very much resembling those which attend the 
termination of the disease, in its acute form. Great debility 
attends the disease, even in the outset; the pulse is small, 
quick and irregular, the tongue foul, sometimes brow r n, the 
urine, at first, pale and copious; but, after a few days, very 
scanty; the extremities are cold, the voice feeble, and very 
often great pain in the head. From the first, there is consid- 
erable cough, and, very soon, a thin and copious expectora- 
tion follows. The disease endures longer than in the inflam- 
matory form. 

TREATMENT. 

In its first stage, this disease will require the active treat- 



262 INFLAMMATORY CATARRH. 

merit that other inflammatory disorders demand ; blood-letting 
should be ordered without delay, and antimonial mixture 
should be immediately given. Take two grains of tartar 
emetic, and two drachms ot" nitre, put it into half a pint of water, 
and give of this mixture, a table spoonful every hour. The 
operation of this medicine should be carefully noticed ; if the 
extremities become cold under it, and the pulse weak, and es- 
pecially if the medicine operates upon the bowels as a cathar- 
tic, give, without delay, a decided dose of laudanum ; from 
sixty drops to a tea spoonful, according to the urgency of the 
case. This prescription is deemed especially necessary here, 
because this form of the disease of the lungs, is particularly 
subject to run suddenly through an inflammatory into a typhus 
state. 

The disease will seldom disappear from the use of a single 
prescription. Indeed it sometimes seems to have a definite 
course to run ; it will last to the ninth or eleventh day, in spite 
of all that may be done. We should be on our guard then 
against the use of remedies too active; for, although we may 
greatly benefit our patients by moderating and reducing the 
grade of diseased action, it would be fatal to him to press 
these remedies too far. If, after the second day, the fever 
continues high, with dry cough, calomel should be given : 
four or five grains a day, from day to day, for three or four 
days, if tht* decline of the patient's strength or the disorder 
does not sooner admonish us to suspend it. The antimonial 
mixture may still, if necessary, be continued, in such doses 
as the patient's stomach is found to bear, without producing 
vomiting. 

Opium is a valuable remedy in this disease. It is to be 
given as before suggested, after the active operation of medi- 
cine, or at night when the patient is restless, and the cough 
troublesome. If the expectoration is free, the laudanum is 
the more necessary. 

In the typhoid or low state of this disease, whether it comes 
at its commencement or towards the close of the inflammatory 
disease of which we have been speaking, the remedies should 
be of the most powerful, stimulating, and supporting charac- 
ter. The name of inflammation carries with it the idea of 
forbearance in the use of stimulants ; but in these cases we 
find a decided exception to that rule. Here there is more re- 
liance in opium than in all other remedies combined ; it is to 
be given twice or oftener in twenty-four hours, according to 
the urgency of the symptoms. Where the extremities are 



INFLAMMATORY CATARRH. 263 

cold, the pulse feeble, and the lungs loaded with mucus, 
which is coughed up by the mouthful, laudanum should be 
given in decided doses; sixty drops, once in twelve hours, is 
a moderate use of the remedy ; and this dose may be given 
every six hours, where the symptoms seem to demand it. — 
Camphor is often beneficially combined with laudanum, in 
these cases. A strong spirit of camphor in equal quantity, 
may be combined with the laudanum. 

Blistering is a valuable remedy in bronchitis, whether the 
disease be more or less inflammatory. A large blister should 
be applied over the region of the pain, and suffered to remain 
until fully drawn. 

Cathartics are a doubtful remedy in bronchitis, in any form. 
In the typhoid, they are decidedly improper ; yet if the calo- 
mel which has been advised, is, for any reason, omitted, and 
the bowels prove costive, they may be moved by a moderate 
dose of castor oil ; but this should not be repeated more than 
once in three or lour days, and when given, should be care- 
fully noticed, and checked with laudanum, if it operates more 
than two or three times. 

The complications of this disorder with measles, scarlet 
fever, small-pox, or other diseases will be treated of when we 
speak of those diseases. 

CHRONIC BRONCHITIS. 

The same mucous membrane of the lungs, which we have 
been considering in its acute forms of disease, becomes some- 
times so affected with inflammation, as to endure for a great 
length of time without destroying the patient. In this form of 
bronchitis, the patient is not confined to his bed, perhaps con- 
tinues able to attend to ordinary business, while still labouring 
under this harrassing and dangerous disease. And here again 
we are bound to acknowledge, that we are not always able to 
decide whether a common cold may have terminated in this 
disease or not. 

The leading symptom of chronic bronchitis is cough, — 
The disease is most common in old persons, and is not attend- 
ed with much pain, and the cough is, many times, absent for 
hours together. But when it comes on, the patient does not 
get relieved from it, till he has expectorated more or less 
freely. To this, however, there are some exceptions, especi- 
ally in the aged, for they frequently have habitually, a short 
cough from this disease, with but very little expectoration at 
any time. 



264 INFLAMMATORY CATARRH. 

The progress of this disease is slow, and if in its course the 
patient is attacked with any other disease, he will probably 
have to endure both that and the bronchitis, with aggravated 
symptoms. Hence it is so often met with in fevers of various 
kinds, and hence it often runs on to a consumption, and is 
charged, whether, justly or unjustly, with producing that fatal 
disease. Certain diseases of the skin sometimes seem to have 
great influence on bronchitis; an eruptive disease, while the 
discharge from it continues, in many instances relieves it. 
But if by treatment, such disorders are relieved, the bron- 
chitis grows worse. It should be recollected, however, that 
some of these eruptive diseases have a venereal origin, and 
yield to the use of mercury, which also, in those cases ; re- 
lieves the disease of the lungs. 

TREATMENT. 

The chronic character of this disease, admonishes us against 
the use of remedies which are too active. If the symptoms 
are inflammatory, pulse strong, and skin hot, bleeding, in small 
quantities at a time, may be repeated, from time to time. — 
Eight ounces of blood would be enough to be drawn at any 
one time. 

Mercury is decidedly beneficial in these cases ; it should 
however be given in moderate quantities, and in its mildest 
form. "Salivation should be avoided. The following is a 
very good prescription; take of blue mass sixty grains, and 
divide into sixteen pills. Of these, take one a day. Where 
the cough is very troublesome at night, and has continued for 
a considerable time, opium may be combined with the blue 
pill, a grain or more with each pill, according to circumstan- 
ces. If the blue pill is not at hand, pills, of a grain of calo- 
mel each, may be substituted for the blue pill. These mercu- 
rial remedies may be continued while they appear to be bene- 
ficial ; and there are few persons who may not use them for 
a month together without producing salivation. 

In many cases it is desirable to avoid the use of mercury, 
and where it has been used for several weeks without obvious 
benefit, it should be abandoned. Ipecac should be used in 
these cases. It may be used in combination with opium ; 
and Dover's powder forms perhaps the best combination of 
this description. It may be given in doses of eight or ten 
grains, once or twice a day. If the cough is hard, and 
very frequent, it will be well to increase the quantity of 



INFLAMMATORY CATARRH. 265 

ipecac. Take twenty grains of ipecac, and make it into 
twelve pills. Five or six of these may be given in the 
course of the day, and thirty drops of laudanum given at 
night. In cases of great irritation, where these remedies 
do not afford relief, the following pill may be tried: take 
of calomel ten grains, tartar emetic six grains, opium twen- 
ty grains ; unite these articles, and make them into twenty- 
four pills, and give two or three a day, according to circum- 
stances. 

Great use has been made of what have been termed expec- 
torants, in this disease. Experience has so deprived these 
remedies of their reputation, that it becomes difficult even to 
point them out. The balsams have, however, a small amount, 
perhaps even too little confidence extended to them, in this 
respect. Of these balsams, the balsam copaiva is decidedly 
the best, and may be used in doses of twenty drops, on sugar, 
three or four times a day. Where the expectoration is copi- 
ous, and the discharge a thick, } T ellow, mucus, I should give 
this remedy with considerable confidence ; indeed I think I 
have seen it very beneficial under such circumstances. Syrup 
of squills is also a valuable expectorant, and may be giv- 
en in doses of sixty drops, twice a day. 

Great attention to the state of the stomach, should be paid 
in this disease ; for it is very commonly attended with great 
disorders of the digestive powers, and, I think, very frequent- 
ly arises from those disorders. The diet should therefore be of 
the lightest and most digestible kind ; yet it should be suffi- 
ciently nutritious, for, in this, as in many other chronic disor- 
ders, the patient should not be placed on a regimen too low. 
In connection with this part of the subject, I may call particu- 
lar attention to the use of alkalies. These remedies neutral- 
ize the acid which is so often present on the stomach, in 
these cases; but they do more; they remove the irritation 
which is productive of great aggravation of the cough, and 
thus save the patient from the most painful part of his suffer- 
ings. I have used these remedies, with the greatest satisfac- 
tion, in these cases. I advise the following prescription: take 
of carbonate of soda an ounce, water eight ounces, mix to- 
gether. Of this solution, half a table spoonful may be given, 
after eating, and repeated several times in the course of the 
day, if the cough proves troublesome. 

Where these cases continue, and our patients are reduced 
to a great degree of prostration, the usual tonic medicines, 
or mineral waters, may be used as restoratives. Take of ex- 



266 INFLUENZA. 

tract of gentian, and precipitated carbonate of iron, combine 
them in such quantities as to make a mass for pills, and form 
into pills of four or five grains each. They will be of the or- 
dinary size of cathartic pills, and of these pills, three or four 
may be taken a day. If the patient is much reduced, tinc- 
ture of gentian may be substituted: a tea spoonful in water 
may be taken, three or four times a day. Wine and spirits 
come in at this stage of the disease, as beneficial remedies. 
They may be used at the discretion of the practitioner. 



INFLUENZA— EPIDEMIC BRONCHITIS. 

This disease has not been intelligibly described till within 
the last century ; but its resemblance to those disorders of the 
lungs which arise from cold, and other occasional causes, is so 
great that it is not at all surprising, that its peculiar character 
should have been so long overlooked. Its resemblance to com- 
mon cold, is so great, that it cannot be discriminated by the 
symptoms of a particular case ; its presence is known only by 
the suddenness with which whole states, and indeed whole 
continents, are involved in it. It was for a long time thought 
to spread by infection ; but the rapidity of its progress is such, 
that it is obviously impossible that it should depend on that 
cause ; and we are left to conclude, that there is some general 
influence in nature from which it arises : but what that cause 
may be, is entirely beyond our comprehension. 

The visit of influenza is known by the sudden attack of a 
great many persons, at once, with the symptoms of common 
catarrh ; but the violence of these attacks differs greatly, at 
one time from another. In some instances, there are but few 
cases which excite much alarm ; but, in others, the attack is 
generally formidable, and very destructive to life. Although 
I have no notes or memorandums of its progress in this coun- 
try in 1807, I well remember the consternation it produced, 
and the many cases of mortality which, in that year, attended 
its progress at the South. 

The manner in which this disease sweeps over the land, is 
perhaps the most astonishing fact in its history. Its appear- 
ance is not more sudden than its disappearance; and it some- 
times attacks, in a few days, all that are to experience its in- 
fluence at that time. And this occurs without regard to sea- 
sons of the year, or any obvious condition of the atmosphere. 



INFLUENZA. 267 

I believe the cause of influenza in different epidemics, differs 
only in degree ; and that the varieties which appear in differ- 
ent cases, depend on the peculiar state of the atmosphere, and 
disorders of the persons attacked at the time of its prevalence. 
Its complications with other disorders are many ; for few es- 
cape its attack, and therefore those who have other disorders, 
labor under the attack of both diseases at once. Its attack is 
most formidable to those who have diseases of the lungs. It 
is much to be dreaded by those who have chronic disease of 
the liver and spleen ; and to such as have chronic diarrhoea or 
dysentery, its attack is also a serious addition to their diseases. 

TREATMENT. 

The treatment of influenza is to be regulated by its symp- 
toms. It is, in many instances, but a common cold, in appear- 
ance and degree, and should be treated accordingly. Where 
the attack is more serious, it is a bronchitis, and is to be treat- 
ed as we have directed in that disease. But it should be borne 
in mind, that this is an acute disorder, from a cause which is 
temporary, and that its treatment should be proportionably 
prompt. 

There is a very important precaution to be taken in influenza. 
The suddenness of its attack, the numerous cases presented, 
and the alarm which naturally arises, are too apt to make us 
think that it is of course to be treated by the most active de- 
pletion. On the contrar} r , when the disease is of the highest 
grade, it is aptest to bring on those typhoid symptoms, which 
forbid the use of depletion. The remedies of an active kind ; 
bloodletting, antimonials and cathartics, are to be used more 
sparingly, during the prevalence of this disease as a general 
epidemic, than in solitary cases of the attacks of similar disor- 
ders, when there is no epidemic prevailing. It will generally 
be proper to give, in the first instance, ten grains of calomel, 
to be followed in six hours, if necessary, with a Seidlitz pow- 
der, o.r small dose of castor oil. If, on the next day, the dis- 
ease does not seem to have abated, give the antimonial mix- 
ture in broken doses ; but not in such quantity as to operate 
very violently. In worse cases, where the fever is high, and 
the pulse full and corded, it may be well to bleed at the 
arm. These remedies are all that will be found necessary in 
common cases. 

The typhus cases, which forbid the use of active treat- 
ment, are known by the prostration of strength which attends 



268 DRY COUGH. 

them. In these cases, the pulse is feeble and rapid, and, in 
extreme cases, the nails purple, and the extremities cold. In 
some instances, there is a flushed cheek, while the rest of the 
symptoms of the prostration we have described, are present. 
Great caution is to be used in administering evacuating reme- 
dies in these cases. Calomel, in combination with opium, is 
the remedy on which our principal reliance must rest. Five 
grains of calomel and two of opium, may be used at a dose, 
and repeated once, twice, or three times, in twenty-four hours, 
according to the violence and danger of the case. Where the 
case is extreme, other stimulants should be used. Brandy is 
perhaps the best, and may be used in such quantity as the case 
requires ; a gill or more, in the twenty-four hours ; and it is to 
be remembered, that in using this article, the quantity is to be 
increased where, the prostration of the patient has been sudden 
and great. It may be used to the extent of a pint or more in 
twenty-four hours. 

Counter irritants which act promptly, such as blisters, mus- 
tard, or cayenne pepper, may be used with great benefit, in 
these cases. And we may close with the remark, that the 
name of influenza, is not to be prescribed for, but the symp- 
toms of the inflammation of the air-passages of the lungs. 
These symptoms are to be treated, in this disease, in the same 
manner as if they had been brought on by any other cause. 
What we have said in reference to the acute form of bronchi- 
tis, is equally applicable to influenza, and should be read in 
connection with its treatment. 



DRY COUGH— DRY CATARRH. 

The circumstances under which cough may take place, are 
of almost infinite variety ; and it will be almost impossible to 
so describe them, as to put the common observer in possession 
of a tolerable knowledge of the cases, which may present 
themselves. The case which we are about to consider, occurs 
without any obvious remote cause, is most frequent in old per- 
sons, but frequently occurs in youth, and childhood, where the 
lungs are of peculiar susceptibility. The cause most frequent- 
ly assigned for this cough, is cold ; but this would not produce 
a permanent disorder of this description, without a peculiar 
liability in the individual attacked. In young persons, an ob- 
stinate dry cough may also be suspected of a tendency to asth- 



DRY COUGH. 269 

ma, if not consumption. In old persons, a cough of this de- 
scription is frequently met with, and may be very obstinate, 
without reasonably exciting so much alarm; " an old man's 
cough" is a sort of proverbial expression. There is one cause 
which is very frequently the foundation of this disease, with- 
out its being suspected ; this cause is indigestion, or irritation 
of the stomach, frequently renewed. 

We have characterised this disease a dry cough ; but it is 
not so dry but that there is, from time to time, a transparent 
glairy fluid raised by coughing ; this sputor sometimes becomes 
greyish, and less tough ; and when the disorder is a little ag- 
gravated by a common cold, or becomes worse of itself, a 
yellow mucus is discharged in considerable quantity. The 
cough comes on in paroxysms, especially early in the morn- 
ing, after a sound night's sleep. At these periods, the cough 
will be, for a considerable time, violent, and a greater amount 
of matter will be raised from the lungs in half an hour, than in 
the rest of the day. But this discharge of matter does not ap- 
pear to afford the patient much relief. On the contrary, his 
voice is rather made hoarse by it, and his breathing, for a con- 
siderable time, will be difficult, and sometimes with wheezing. 
Persons in this disease, enjoy a tolerable degree of health for 
many years ; but it is a source all the while of particular dan- 
ger, and should be carefully regarded, and diligently treated. 

REMEDIES. 

Where the dry cough is produced by irritation of the stom- 
ach, especially when acids caused by indigestion produce it, 
the use of such absorbents and alkalies as correct this acid, is 
attended with the greatest benefit. These remedies should be 
habitually used. Fifteen to thirty grains of prepared chalk, 
may be given, two or three times a day, especially after meals. 
A solution of carbonate of soda, or potash, may be used with 
equal benefit. Dissolve an ounce of carbonate of potash, or 
soda, in eight ounces of water, and take a small table spoonful 
after breakfast, and after dinner. But these remedies, al- 
though exceedingly beneficial, do not strike at the cause of the 
disease, and are not to be used to the exclusion of others. In 
serious cases, where the cough is distressing, and the patient 
not too much exhausted, give the following pill : take of calo- 
mel twenty grains, powdered squills sixty grains, mix together, 
and make into twenty pills ; of these pills, one, two, or three 
a day, may be used, according to circumstances. But it is to 



270 ASTHMA. 

be observed, that three a day will probably, if continued for a 
week or longer, produce salivation. The variety of syrups, 
mucilages, and expectorant mixtures, which have been recom- 
mended, need not be recapitulated here. Where they are not 
made too stimulating, by the addition of balsams and spirits, 
they are not objectionable ; they may contribute to the patient's 
comfort, if not to his safety. 

This disease sometimes runs to extremity, and patients are 
reduced by it to the verge of the grave. Laudanum, which in 
its earlier stages, is productive of more harm than good, be- 
comes, at last, a valuable remedy ; thirty drops may be given, 
once or twice in twenty-four hours. Ten or fifteen grains of 
Dover's powder, may be given in place of the laudanum, 
where it can be taken without exciting vomiting. In this 
stage of the disease, tonics and stimulants become necessary. 
The extract of gentian in pills, used alone, or in combination 
with carbonate of iron, will answer the purpose as well as any 
other. Brandy or wine may be used as a stimulant, at the dis- 
cretion of the person affected. A single remark, and we have 
done with dry cough. Where it arises from a disordered 
stomach, it is by no means to be considered an incurable dis- 
order, although the patient be old. Diligent attention to the 
digestive organs, is especially demanded in these cases. The 
patient is to be considered a dyspeptic, and is to be treated 
with all the diligence necessary for the removal of that disease. 



ASTHMA— PHTHISIC. 

This disease is universally known by the difficulty of breath- 
ing it produces. It occurs under various circumstances, is re- 
stricted to neither age nor sex, and may continue throughout a 
reasonably long life. Its cause is not known ; and it is barely 
suspected to be a spasmotic disease of the muscular fibres, of 
the air vessels of the lungs. 

The obvious causes which bring on attacks of asthma, are 
those which act especially on the lungs. Changes in the at- 
mosphere, suffocating gasses, dust, and other similar causes, 
often bring on the attacks of this disease. I have known in- 
dividuals who did not dare to enter a flouring mill, and one 
poor boy who did not dare to ride a horse canning a bag of 
flour, for as sure as he did so, he would experience a violent 
paroxysm of asthma. Causes operating through the mind, 



ASTHMA. 271 

sudden emotions of any kind, have also been known to bring 
on the attack. 

SYMPTOMS. 

Persons subject to asthma have always seasons of respite ; 
sometimes they pass weeks, even months, without feeling the 
disorder. The attack usually approaches, with pretty obvious 
pre-disposing symptoms. The stomach becomes very much 
disordered, vast quantities of air are belched up, and thrown 
off from it ; great languor and heaviness prevail ; and the pa- 
tient, although not experiencing any particular pain, is under 
an indescribable oppression. The paroxysm at length comes 
on very suddenly, commonly at night. Great constriction of 
the chest, and difficulty of breathing force the patient to rise, 
and throw himself in a position to expand his lungs to the 
greatest extent ; his respiration becomes loud and wheezing, 
and his demand for fresh air irresistible ; he will throw open 
the window and expose himself, half clothed, to the air, how- 
ever inclement the weather. And it is observed, that exposure 
under these circumstances has seldom resulted in any injury. 
In this stale of agony, the face is haggard and pale, the ex- 
tremities cold, the body covered with perspiration, and the 
pulse small, quick, and frequent. As the disease progresses, 
the pulse rises, the face becomes flushed, and the skin dry. 
The patient is no longer compelled to retain his position at the 
window, but retires to some part of the room, where half seat- 
ed, and half lying, he obtains a slight degree of remission from 
his sufferings. These symptoms sometimes continue for two 
or three days, when they gradually subside, and the patient is 
restored to about the same degree of health, he had previously 
enjoyed. 

In this disease, each case is a particular study. It is agreed 
that we have no specific remedy for it, and that our efforts are 
limited to lessening and guarding against its remote causes, 
and palliating the distressing s} r mptoms of the paroxysm. 
Now every paroxysm seems to enlighten us, on the causes 
which induce it, and the patient who notices these circum- 
stances will be greatly benefited by care in avoiding them. If 
for instance, his paroxysm comes on after eating a supper of 
lobsters or* fish, or any other cause which produces disorder of 
the stomach, he will know how in future to avoid such an error. 
If confined air in a close room brings it on, he will seek a reme- 
dy in the open fields, and if the luxury of lying in bed proves an 



272 ASTHMA. 

exciting cause, he will forsake and abandon even this luxury, 
and spend the nights of a hard life on chairs or sofas. 

TREATMENT. 

It is agreed that there are cases of this disease particularly 
nervous, where the use of stimulants, such especially as opium 
and asafoetida, are administered with success. These cases, 
I must consider rare ; for I have not, in all my practice, met 
with a single one of them. In every case that I have treated, 
any stimulant administered at the onset of the disease, even a 
dose of laudanum, has been attended with an aggravation of 
the symptoms. Yet I feel bound to consider such cases not 
very uncommon, and where the patient was particularly ner- 
vous, and especially where the attack had been brought on by 
any sudden excitement of the mind, I should feel authorised to 
administer a stimulating anodyne; sixty drops of laudanum, or 
something equivalent. 

In a great majority of cases, where the attack has come on 
suddenly, and the patient is not exhausted to a very low and 
dangerous degree, I give, without delay, an emetic of antimo- 
nial mixture. Take two grains of tartar emetic, and a drachm 
of nitre, put it into eight ounces of water, and give a table 
spoonful every fifteen minutes, till it operates as an emetic. 
Where the patient knows by former experience, that an ordin- 
ary dose of emetic medicine' will not operate, the tartar emet- 
ic may be increased in due proportion. If this remedy does 
not afford relief, and the countenance becomes flushed, and the 
pulse strong after the operation is over, a pint of blood may be 
drawn from the arm. These remedies have succeeded so well, 
in my hands, that I do not know from experience much of the 
operation of others. There are, however, several which have 
been highly spoken of. The best of these is lobelia, and al- 
though I have not myself administered it in these cases, 1 think 
it merits a trial wherever the disorder is obstinate, and subject 
to frequent returns ; for there is reason to believe, that the in- 
terval which will succeed the use of this remedy, will be more 
perfect and longer than after the use of other emetics. In ca- 
ses in which the paroxysms become as it were chronic, and the 
patient is almost all the time tormented with great difficulty of 
breathing, preparations of squills have been beneficially used. 
From thirty to sixty drops of syrup of squills, may be taken, 
three or four times a day. 



ASTHMA. 273 

The intervals, or marked remissions, which take place in 
this disease, would appear to afford the most favorable time 
for its treatment and cure. Less benefit has been derived from 
remedies given during these remissions, than might have been 
anticipated. I have found a remarkable difference in the con- 
dition of different individuals, during the remissions in this 
disease. In some, there is a decidedly inflammatory diathesis 
prevailing all the time. And to such I have administered an- 
timonial mixture, continued for a great length of time, with 
much benefit. In these cases, I have lessened the tartar emet- 
ic, and increased the nitre used in the prescription. Take one 
grain of tartar emetic, and four drachms of nitre, dissolve in 
half a pint of water, and give two tea spoonsful, three or four 
times a day. I have used this remedy for many days in suc- 
cession, with the greatest advantage. But in other cases, the 
patient seems to be too much debilitated for such a course, and 
the stomach especially seems to lose its tone, and to require 
tonics and stimulants, for the restoration of its powers. The 
particular tonics suited to this disease, have been thought to 
be mineral waters ; especially those containing iron, together 
with travelling, and gymnastic exercise. There is no disease 
in which free exposure seems more beneficial. I have known a 
gentleman who seemed scarcely capable of living, except when 
exposed like a common wagoner, encamping in the open air, 
enduring great fatigue, privation, and hardship, and seldom 
entering a house. A return to the comforts of a close dwelling 
and warm bed, was almost sure to bring on a violent attack of 
asthma. 

I have omitted to mention a remedy of considerable power 
which has been much used in this country ; I allude to the 
stramonium, or Jamestown weed. 1 have never administered 
this remedy in substance, but have often advised the dry leaves, 
or dead stalk of the plant reduced to dust by rasping, and 
smoked like tobacco in a pipe. This sometimes affords great 
relief during the paroxysm, and should be tried by persons who 
are sufferers from this disease. 

A perfect cure in asthma is not to be promised to our pa- 
tients ; it is too rarely so perfectly removed that it will not re- 
turn again, when the patient is exposed to its exciting cause. 
Still the benefits of a systematic treatment, and the proper ad- 
ministration of remedies, from time to time, are very great. 

18 



274 HOOPING COUGH. 



HOOPING COUGH—PERTUSSIS. 

This is a disease, which is experienced but once in life. It 
is commonly a disease of childhood, spreads through families, 
and sometimes through the country, as a general epidemic. It 
has long been considered contagious ; but it is now doubted, 
whether hooping cough arises from contagion, or from some 
inscrutable influence or cause in the atmosphere. 

The leading symptom of this disease, as its name implies, 
is a cough. In its commencement, its resemblance to an at- 
tack of common cold, is too close to be successfully discrim- 
inated. After a few days, the peculiarity of the symptoms be- 
gins to manifest itself; the cough comes on in paroxysms, after 
considerable intervals. The attack is sudden, the cough forc- 
ed on a great many times in one breath, with such a total ex- 
piration of the air from the lungs, that the patient recovers his 
breath with great difficulty, and commonly with a loud hooping 
noise. The struggle for life seems to be violent; the little pa- 
tient clings to anything it can lay hold of, calls for aid, and de- 
sires to be held, and during the violent part of the cough seems 
to be so nearly suffocated, as to turn almost black in the face. 
In a few moments, however, the paroxysm passes off, and the 
little sufferer returns to its play, with as much alacrity as ever. 
In the suddenness of the motion given to the lungs in this 
cough, there is great resemblance to convulsions ; and the dis- 
ease has been considered convulsive in its character. When 
r£it is violent, it will not be mistaken for any other cough : the 
strangling,, the loud hooping, and dreadful extremity of the at- 
tack, are? altogether peculiar. These attacks produce, as might 
be expected,' great suffusion of the vessels of the face and 
head ; the eyes are bloodshotten, and the face tumid and bloat- 
ed. These symptoms continue, with a gradual increase, for 
two or three weeks, and sometimes much longer. I'he lungs 
take on a copious secretion of ropy mucus, which is largely 
discharged by coughing. 

Hooping cough is always a formidable disease ; but, in many 
instances, becomes greatly aggravated and alarming. Fever 
supervenes at an early stage ; and convulsions are not uncom- 
mon. The lungs, in many cases, take on a violent inflamma- 
tion ; and even the brain is sometimes fataly disordered. In 
this alarming state, the sprightliness of the patient gives way, 



HOOPING COUGH. 275 

congestion of the brain, with great drowsiness follows, and 
death is a frequent consequence. 

TREATMENT. 

So obstinate and uncontrollable is hooping cough, that many 
doubt the benefit of remedies in it. I do not dispute that it 
runs to its own time, and keeps its own course, and there are 
few diseases in which I offer remedies with less confidence. 
Still there can be no doubt, that the violent symptoms we have 
described, will be lessened by proper remedies. The fulness 
of the blood-vessels, and congestion of the brain, will surely 
be moderated by proper evacuations ; and there can be no 
doubt of great benefit being derived from proper attention to 
the state of the stomach. I shall not offer a list of the hundred 
infallible remedies, which have been published for hooping 
cough. Not one of them has borne the test of experience ; 
and we are left to treat the disease upon common principles, 
acknowledging in the outset, that we have no specific remedy 
for it. 

Where the attack is mild, producing symptoms of common 
cold without hooping, for the first five or six days, it is unneces- 
sary to give any remedy ; but where the disease is more vio- 
lent, and the hooping commences within two or three days of 
the attack, with more or less fever, an emetic should be given. 
Take of tartar emetic two grains, nitre two drachms, dissolve in 
eight ounces of water, and, to a child six years old, give a tea 
spoonful every fifteen minutes, till it operates as an emetic. 
This remedy may be repeated from time to time, if the symp- 
toms continue violent; but if the patient, as is very common, 
throws up almost every time he coughs, demanding food im- 
mediately afterwards, no remedy should be given to him, al- 
though the symptoms be considerably violent ; for these cases 
have almost invariably favorable recoveries. Where the pa- 
tient is feeble and young, say two years old or under, it is safest 
to give ipecac as an emetic ; give four grains of ipecac every 
fifteen minutes till it operates. Where the drowsiness and 
other symptoms of congestion about the brain happen to take 
place, bloodletting will be advisable ; and if it is found im- 
practicable to accomplish it with a lancet, cups and leeches 
should be resorted to in its place. Where the complication is 
with inflammation of the lungs attended with great pain, fever, 
and tenderness about the chest, calomel should be given, and 
blisters applied. With these remedies, the first stage of the 



276 HOOPING COUGH. 

disease is to be met ; and this first stage commonly lasts two 
or three weeks. For the disease is so obstinate and lasts for 
such a length of time, that in spite of the acuteness of its 
symptoms, it is rather a chronic, than an acute disorder. Still 
it has a first and second stage ; and the remedies we have ad- 
vised are those suited to the first stage, which commonly con- 
tinues about three weeks. 

After this time, where there is any danger, it will begin to 
manifest itself by great debility and prostration. The lungs 
become exceedingly loaded with phlegm ; the breathing is fre- 
quently heard, without very close listening, producing a rough 
or rattling sound; the face becomes pale, the pulse rapid, and 
the extremities cold. Tonics and stimulants should now be 
used. The carbonate of iron has been much extolled, and I 
have used it with great advantage. Take sixty grains of car- 
bonate of iron, (the red precipitated carbonate is best,) add to 
it eight tea spoonsful of syrup or molasses ; rub together, and 
give to a child six }^ears old, a tea spoonful three times a day. 
Laudanum is an important remedy here; where the cough re- 
turns in frequent paroxysms, and the patient is worried and 
much exhausted, laudanum may be given in doses of ten or 
fifteen drops, to a child six years old, once or twice in twenty- 
four hours. Assafoetida has been much used at this stage of the 
disease. It is one of the remedies which was once published 
as a specific for the disease. I have but little experience of its 
use; but, considering the nervous and . convulsive character 
of hooping cough, and regarding with high respect the authori- 
ties on which it has been recommended, I have no hesitation 
in advising the use of it. A child six} T ears old may take twen- 
ty or thirty drops of the tincture, three or four times a day. 
The carbonate of potash has been very much used in this dis- 
ease, and I have directed it with considerable advantage. It 
is peculiarly applicable to the last stages of the disorder ; and 
may be given in doses of four or five grains to a child six years 
old, three or four times a da} 7- . Fowler's solution of arsenic 
has also great reputation as a remedy at this stage of the dis- 
ease. 4t may be given in doses of from four to six drops, three 
times a day, to a child six years old. Sulphate of quinine 
would seem to promise more than any other remedy, in the 
last stage of hooping cough. It has been strongly recommend- 
ed by able writers ; but I confess I have been disappointed in 
it. It is no tonic, and has not appeared to me to arrest the par- 
oxysms of the cough, as it does those of other diseases. Where 
the patient becomes very much exhausted, and the disease has 






BLEEDING FROM THE LUNGS. 277 

continued for a length of time, I recommend a return to a gen- 
erous diet, and a reasonable use of pure stimulants, brandy 
tody in preference to anything else. 



PULMONARY HEMORRHAGE— BLEEDING FROM 
THE LUNGS. 

This is a most fearful disease. It does not always signify 
a serious disease of the lungs ; but from whatever cause it 
arises its tendency is alarming. The blood, in some instances, 
flows from vessels in the lungs which have been ruptured or 
broken by disease. On the contrary, when death by suffocation 
has taken place, and the effusion of blood proportionably large 
and sudden, the dissector has sometimes sought in vain for 
ruptured vessels, or broken organs. The blood in these cases 
seems to transude through the coats of the unbroken vessels, 
and to produce death in cases where in would be least ap- 
prehended. 

Hemorrhage from the lungs is a disorder of frequent occur- 
rence, and depends on many remote causes ; sometimes it ari- 
ses from pressure made on the lungs by dropsy, sometimes 
from aneurism of the heart ; not unfrequently it is a vicarious 
discharge brought on to supply the place of some other, espe- 
cially the menstrual flux. The danger in these cases will cor- 
respond with the character of the remote cause. When it 
arises from suppressed menstruation, it is not considered dan- 
gerous, and sometimes appears for years to return, from month 
to month, and yet the patient suffers very little deterioration of 
health. 

The free discharge of blood from the mouth, is the particular 
symptom of this disease ; but as blood may be spit up from 
other sources besides the lungs, it is necessary to guard against 
mistakes. The blood, when it arises from the lungs, will be 
raised by coughing, although the cough will, in many instances, 
be very slight, and the blood burst forth as it were spontane- 
ously. Still, if the physician is present, a very slight degree 
of attention will enable him to decide positively whether the 
blood is raised by coughing, flows from any point about the 
mouth, nostrils, or throat, or is raised from the stomach by 
vomiting. 



278 PULMONARY CONSUMPTION". 

TREATMENT. 

The first remedy which would suggest itself, in these cases, 
is bloodletting. The patient should be placed in an erect po- 
sition, and blood drawn from the arm in a full stream. It is 
not easy to specify the amount which should be taken ; it is 
easy, however, to push the remedy too far, and I have no 
doubt this is very commonly done. Calmness is particularly 
necessary in the physician here ; his patient while placed in 
this position, and the blood flowing, will commonly have a ces- 
sation in the discharge from the lungs in a very short time, but 
he will still raise blood by coughing; because the whole that 
is discharged in the lungs, cannot be gotten rid of at once. If 
some degree of faintness comes on from the discharge, it will 
be for the better, but the instant it is perceived, the blood 
should be stopped. If the flow of blood continues, the patient 
should not, if he can avoid it, change his position ; he should 
be kept as cool as possible, and observe the strictest silence. 
When the discharge has so far subsided as to admit of it, he 
may take his position in bed. Where the discharge of blood 
continues, though in a degree moderated, the best remedy 
known to suppress it, is sugar of lead. Five grains of this ar- 
ticle dissolved in water, may be given hourly, if necessary, till 
twenty grains are taken. The patient is now to be allowed 
quietness, time, and rest. If he is feverish, which is very apt 
to be the case, a cathartic of Seidlitz powder or Epsom salts, 
may be given. 

These remedies, continued according to the circumstances 
of the case, will commonly relieve an attack of hemorrhage 
from the lungs. The remote causes which have given rise to 
it, will then be the object of the physician's care. They are 
all treated of in connection with the diseases to which they be- 
long, and nothing further need be said of them here. 



PULMONARY CONSUMPTION— PHTHISIS PULMO- 
NALE. 

Few diseases have been more examined of late than this — 
none are looked on with the fear it inspires. It is known by a 
discharge of matter from the lungs by coughing ; but this may 
happen in other diseases besides consumption. The disease 
which we are about to consider, is thought to arise exclusively 



PULMONARY CONSUMPTION. 279 

j from scrofula. It admits of no cure ; the best which can be 
I hoped is to put back, and restrain a lingering disease, under 
which the patient must at last sink. The disorder is by no 
means confined to the lungs, but is considered general, and in 
I many instances, displays itself in other organs. But its final 
and fatal attack is made on the lungs and intestinal canal. 
Tubercular consumption is a hereditary disease, descending 
I from parents to children, and, many times, exterminating whole 
families. It is a prevailing notion, that it is most apt to occur 
I in the most intellectual and talented classes ; but the observa- 
I tion which it has been in my power to make, has not satisfied 
I me that this is true. The individuals who will be subject to 
the attack of this disease, are said to manifest this tendency 
| from childhood. This also is a maxim which I should not be 
J able, from my own observation, to confirm. The scrofulous 
I disorders which attack children, and are thought to precede 
I this fatal disease, are, by no means, so common in this climate, 
f as they are represented to be in higher latitudes. Nor have I 
seen the glandular swellings, and protracted suppurating disea- 
ses, which sometimes even here occur in children, followed, 
I with any uniformity, by the attack of consumption. Strong 
i suspicion of danger will be felt in cases where individuals 
i have lost many relatives by this disease ; but unless the sus- 
i picion arises in this way, persons who are doomed to suffer by 
| consumption, are often happily ignorant of their doom. 

Tubercles in the lungs exist for a long time before they re- 
sult in consumption. Many persons who die from other cau- 
ses, are found to have them in great numbers, but little de- 
veloped. They are said, in the first instance, to be an unor- 
ganized, cheese-like matter, deposited in the substance of the 
1 lungs. This commonly happens in small points, not larger 
than small shot. They are commonly situated in the upper, 
or back part of the lungs, below the collar bone, and backward 
from that point. These small tubercles become softened and 
enlarged by time, till at last they produce suppuration, are de- 
tached, and coughed up. There is nothing in the nature of 
things to hinder the healing up of the places from which these 
tubercles are discharged ; but there are commonly others near 
the same place, progressing to the same result. The size of 
these tubercles when matured, varies very much ; they some- 
times seem to fill almost the whole of the upper lobe of the 
lungs ; but, in other cases, they are exceedingly small, some- 
times not larger than a pea. 

The length of time which these tubercles may remain dor- 



280 PULMONARY CONSUMPTION. 

rnant and inactive, has not been ascertained. There is rea- 
son to believe that in some persons who have died at mature 
age, and been found on examination to have latent tubercles, 
they have existed for a great length of time. When the tuber- 
cle bursts, and its contents are discharged, the cavity left is 
called a vomica. These cavities do not close, but are often 
found with a lining membrane from which the discharge of 
pus has been kept up. In a few cases, they are found to have 
closed and healed, and thus exhibit cases of consumption cur- 
ed ; but we are not authorised to say that we know anything 
of the agency of remedies in the happening of these cures. It 
would be useless to pursue the subject of the various changes 
which have been found to have taken place in the lungs, in 
the thousands of examinations which have of late been made, 
after death from consumption. 

The lungs manifest the first symptoms of consumption ; but 
they are by no means the exclusive objects of its attack. The 
intestinal canal soon follows in the same course of disease ; and 
here indeed it is more rapid, and speedily fatal. In some in- 
stances, the intestines ulcerate, and holes are formed through 
which their contents are discharged into the abdomen. But 
patients seldom live to experience this result ; they are com- 
monly carried off by a wasting diarrhoea which comes in at the 
close of the disease, and is fatal before ulceration has taken 
place. 

SYMPTOMS. 

Cough and difficulty of breathing are the first symptoms 
usually noticed in consumption. There is at first scarcely 
any discharge from the lungs ; but in some cases blood is 
coughed up at a very early stage. Hectic fever soon follows 
these symptoms ; and night sweats begin that process of wast- 
ing, so characteristic of this disease. Hoarseness follows, with 
more or less feebleness of the voice ; and after these symptoms 
have continued for a length of time, a fatal diarrhoea super- 
venes. 

Great pains have been taken to discriminate consumption 
from other diseases of the lungs ; but after all, there will re- 
main a doubt and uncertainty of the nature of the case, till the 
inroads it has made have brought the patient to the point of 
death. I am not very certain that it is desirable to reduce this 
knowledge of the nature of the disease, to more certainty than 
we now have in regard to it. To me it would be exceedingly 
painful to say to a patient, that he must inevitably die of his 



PULMONARY CONSUMPTION. 281 

complaint ; and there are very few cases in which it would be 
desirable that such a communication should be made, to one 
who may yet live for months or years. Yet to the physician, 
it is desirable to be able to discriminate this disease from oth- 
ers, and great pains have been taken to accomplish it. The 
matter discharged by cough from tubercular ulcers, has been 
described with great particularity. It has been said to be 
thrown offin "globular, floccident masses, which look like little por- 
tions of wool" The matter thus discharged is said to be par- 
ticularly attractive to flies ; and this fact I have very often no- 
ticed. These circumstances are obviously subject to conside- 
rable variation in different cases, and the mist of uncertainty 
which will hang around the mind of the physician, becomes in 
that of the patient a thick cloud, and his hopes predominate 
over every other feeling to the last. The fever has something 
of the form of parox}^sms ; once a day there is a degree of chil- 
liness, which is followed by a {ever, terminating in profuse and 
wasting perspiration. The sweating, in these cases, is exces- 
sive, and out of all proportion with the fever it succeeds. It 
is a leading symptom during the whole course of the disease, 
and seems to go on, increasing almost to the last. The pulse, 
at first, is a great deal more frequent than might be expected ; 
and the disease is attended with extreme debility, even from 
the first. Diarrhoea is sometimes an early symptom, in con- 
sumption. It is perhaps the most certain sign of a speedy and 
fatal termination. Great pain cannot be considered a charac- 
teristic of the disease ; but, in the intestines, towards the close 
of the disease, the pain is sometimes exceedingly distressing. 
Towards the close of the disease, symptoms of dropsy appear; 
the feet become swollen ; but this is fortunately not to last a 
great while, for the patient, reduced to a state of existence too 
low to desire its continuance, is relieved by death from his 
sufFe rings. 

It is doubtful, whether under any circumstances consumption 
is]contagious; and it is certain that many wives nurse to the last, 
their consumptive husbands, without contracting the disease. 
This fact is so general, that it takes away every excuse from 
those who would falter in their attention to near relations, in so 
dreadful an extremity. Still, I am bound to say, that prudence 
requires a guarded intercourse with the sick and dying in con- 
sumption ; and I will add, that 1 fear I have seen cases, in 
which the disease has been contracted by sleeping on the same 
bed with one in the last stage of consumption. 



282 PULMONARY CONSUMPTION. 

TREATMENT. 

Doctor Rash, who simplified every subject of which he 
treated, insisted on it, that the principal, if not the sole predis- 
posing cause of consumption, was debility. Subsequent ob- 
servation has not borne him out, to the entire extent of his 
theory ; but it is conceded on all hands, that persons who have 
a predisposition to this disease, become, in an unaccountable 
way, exceedingly debilitated, about the time of its attack. 
The maxims of this great physician, although not entirety borne 
out, point still to the most valuable of all our means of treat- 
ing consumptive disorders. The first principle then, is, to 
avoid all causes of debility, and to maintain, by every possible 
means, the activity, power, and endurance of the body. Per- 
sons who are supposed to have a tendency to this disease, 
should make the preservation of a high degree of health a 
first consideration. This they will be enabled to do, in a great 
degree, by their own observation and experience. But the 
testimony in favor of free exercise in the open air, is too strong 
to be resisted. There seems to be a special aversion in con- 
sumptive persons, to muscular effort ; and they should be put 
into some employment that will demand from them, a daily 
and very considerable degree of exercise. Doctor Rush's 
great remedy, or means of pieventing this fatal debility, was 
exercise on horse back. He pleased himself with stating in 
his lectures, the case of a man who, bv his advice, took a con- 
tract to carry a country mail on horse-back, over a route ex- 
ceedingly rough and fatiguing. His symptoms of consump- 
tion speedily disappeared ; and when he felt himself well 
enough, he retired from his disagreeable employment ; but the 
reappearance of his symptoms of consumption drove him again 
to the road, where he spent many years in health and vigor. 
But a remedy so rude and trying, cannot be recommended to 
all ; and we are to substitute the best means we can, in their 
place. Every act of life is to be taken' in reference to this im- 
portant subject. Patients who have a hereditary taint, or who 
have seen their kindred or ancestors dropping off by this dis- 
ease, should beware in contracting marriages, of allying them- 
selves to those who are placed under the same circumstances. 
All may pursue a life of strict regularity, all may avoid excess 
in eating and drinking, all may follow habits of purity and 
cleanliness, and all may avoid entering into anything which 
would exhaust and debilitate them in a very great degree. It 
has been observed that study was apt to increase the s} T mp- 



PULMONARY CONSUMPTION. 283 

toms of consumption ; the rule should be to employ both body 
and mind, in moderation. I think persons of intellectual en- 
dowments whose taste is chiefly gratified by the things of let- 
ters and science, would not be sufficiently compensated by 
refusing themselves the gratification of study. 

A change of residence to a warm climate, has been highly 
recommended ; and families who have reason to think them- 
selves in particular danger, should remove without waiting to 
be driven by the attack of the disease. For the disease, when 
formed, respects no climate. Tubercles will mature, soften, 
and suppurate in any part of the world. It is not, therefore, 
the degree of warmth to which a person may be exposed ; but 
the irregularities in conduct, and the rude changes of the sea- 
sons, which are so often the exciting cause of this disease. 
The best climate is that which is most uniform, and the least 
subject to the prevalence of common colds. In this regard, 
many people of the United States, have very beneficially taken 
up a temporary residence in Cuba, or some other of the West 
India Islands. In Europe, the Island of Madeira is very much 
resorted to for ihe same purpose. But it is by no means in 
the power of every one to procure the benefits of a change of 
climate. They must content themselves with adopting the 
best course of living and exercise within their reach. And it 
has been thought, that great benefit has been derived from a 
scrupulous regard to the adaptation of clothing to the warmth of 
the season. 

A great deal has been said in reference to regimen, in these 
cases — some insisting on the most nutritious and supporting, 
while others have run into the opposite extreme. My own 
opinion is in favor of a decidedly nutritious and supporting 
diet, while the patient is enabled to take a great deal of exer- 
cise. The time to lessen or forbid food will manifest itself by 
the presence of fever. Beyond this, the discretion of the pa- 
tient and his attendant must govern him. 

But we are not allowed to hope that these remedies of pre- 
vention, are to serve the purpose of arresting the disease in all 
cases. It will make its slow, desceptive, and fatal inroad ; yet 
the symptoms it produces demand from us the use of certain 
remedies ; and experience warrants us in saying, that they are, 
in many cases, beneficial. It will not be going too far to say, 
that, in some instances, they have proved effectual, and result- 
ed in a cure. For patients who have died of other diseases, 
have, on examinations after death, shown evident signs of con- 
sumptive ulcers which had been cured. The maxim, it is 



284 PULMONARY CONSUMPTION. 

true, is, that consumption is incurable ; but this maxim is 
founded on the common belief, that the person who recovers 
from any disorder of the lungs, has not had this disease. Our 
efforts, therefore, are not entirely without hope ; and it is our 
duty, especially in the onset of the disorder, to use the proper 
remedies with great diligence and perseverance. These reme- 
dies should in all instances be moderate in their force, and so 
administered as to produce effects the least debilitating. The 
first remedy to be mentioned is bloodletting ; the remedy al- 
most universally beneficial in that degree of inflammation 
which produces suppuration. It should not be resorted to till 
the fever is manifest, and the pulse rapid, and, in some degree, 
strong ; but night sweats do not always forbid its use ; for 
these sweats seem to be an especial ingredient in hectic fever. 
Bloodletting, to be useful, should be practiced during the most 
excited stage of the fever, commonly about mid-day; and where 
the patient is feeble, half a pint, or even less, will be sufficient. 
This remedy is far from being the debilitating agent that might 
be expected, in these cases. If it arrests, or greatly lessens 
the night sweats, it has done more benefit than injury ; it has 
increased rather than lessened the patient's strength. It will 
not be often in our power to repeat the operation many times 
profitably ; for if this remedy, or others used at the time, are 
not very beneficial, the patient will soon pass on to a state of 
debility, which will altogether forbid the use of the lancet. 
Emetics are also useful here ; and of these, decidedly the best 
is tartar emetic. It may be given in doses of a grain, every 
half hour, till it proves emetic : and such is the course recom- 
mended in the first stage of the disease when the fever runs 
high. At a later stage, I prefer the use of the antimonial mix- 
ture, in broken doses. This remedy should be given during 
the highest part of the fever, commonly from twelve o'clock till 
evening ; the mixture should be given in doses which will not 
produce vomiting, and at intervals of two or three hours. If 
the remedy in this way acts as a cathartic, twenty or thirty 
drops of laudanum should be immediately given ; and, if this 
tendency to increased action of the bowels continues, the reme- 
dy is to be altogether abandoned. 

It is seldom that this disease requires the use of cathartic 
medicines ; if, however, any considerable degree of costive- 
ness prevails, pills of rhubard may be given to produce a very 
moderate action. I have given, in these cases, with some sat- 
isfaction, the following pill : take of rhubard one drachm, ipe- 
cac thirty grains, mix and divide into twenty-four pills. Of 



PULMONARY CONSUMPTION. 



285 



these pills, one may be given as often as is found necessary. 
Opium is a palliative, indispensible to us in the treatment of 
this disease. It may be used, from, time to time, when great 
prostration and difficulty of breathing evince the great necessity 
of support. It is equally demanded for the relief of the great, 
and sometimes intolerable pain felt in the intestines. As to the 
preparations of this remedy, the Dover's powder has been 
most approved ; it may be given once or twice in the twenty- 
four hours, in doses often or fifteen grains ; but as the disease 
progresses, the physician will find himself almost compelled to 
increase the quantity of opium. Laudanum should now be 
substituted, and the dose increased according to the necessity 
of the case. I have found myself almost compelled to increase 
the quantity from thirty to forty drops, at length to a tea spoon- 
ful, and finally to twice that amount ; for the sufferings of the 
patient, without its use, were too great to be borne. 

The diarrhoea, which almost always comes on sooner or la- 
ter, requires special attention. It is not expected to cease by 
the use of remedies. Opium is perhaps the best palliative in 
our possession, and is to be given according to circumstances. 
The preparation which I have found best, is a combination of 
opium or laudanum with prepared chalk. Take of prepared 
chalk two drachms, drop on it thirty drops of laudanum, rub 
together, and divide into six powders. One of these powders 
may be given two or three times a day ; and if the stage has 
arrived when a greater amount of laudanum is necessary than 
these powders contain, it may be given separately. Many 
remedies have been advised for this diarrhoea. The astringent 
vegitables are to be preferred. Take of gum kino a drachm, 
powder it finely, and divide it into six powders — give one three 
times a day. It would be easy to add indefinitely to this list 
of remedies ; but we should gain but little by trying the whole 
of them. Those I have advised are amongst the best. 

The proverbial sanguine temperament of consumptive pa- 
tients, operates beneficially in preserving their energies to the 
last, and carrying out every suggestion which may benefit or 
relieve them. They are not to be abandoned in despair, but 
allowed to pursue such schemes of exercise as may promise 
them benefit. They are to use, in the last stages of the disease, 
such tonic medicines as tend most to support the system. The 
muriated tincture of iron is perhaps the best of these — and 
from ten to fifteen drops may be given two or three times a 
day. Pure stimulants have also a proper place here, and we 
need hardly add that brandy is the best of these. A tea spoon- 



286 "FOREIGN BODIES IN THE WIND-PIPE OR LUNGS. 

ful or two, made into toddy or drunk with water, at the pa- 
tient's pleasure. And when we are brought to the last ex- 
tremity, we are not to forget that opium is still our surest and 
best reliance, for the degree of relief which it is in our power to 
offer. Very little is, in my opinion, gained by changing opium 
for Prussicacid, hemlock, henbane or other powerful narcotics. 
I should not think of resorting to them. 



FOREIGN BODIES IN THE WIND-PIPE OR LUNGS. 

To those who understand the anatomy of the throat and 
wind-pipe, it is most astonishing that substances taken into the 
mouth, do not oftener find their way into the wind pipe, or in 
common parlance, go the wrong way. Nature has provided 
against this accident by a contrivance peculiarly simple, yet 
sometimes, from inattention or accident, it is insufficient. Ma- 
ny substances are drawn into the wind-pipe, and produce ex- 
ceedingly injurious or fatal effects. This commonly happens 
from inadvertance — the person drawing breath suddenly, 
when the substance in the mouth is in a position to be acted on, 
and thus drawn into the wind-pipe. Diseases sometimes place 
the parts in a situation to perform their office badly, and thus 
increase the number of these accidents. 

The substances most frequently drawn into the lungs, are 
of a character so light, as to be easily moved by a current of 
air. A head of barley or timothy, or leaves of cedar, and 
other light articles, I have known to find their way into 
the air passages. Heavier bodies sometimes fall in, by 
passing into the throat, when no effort is made to swallow, 
and thus dropping into the windpipe. This most frequently 
occurs with the seeds of fruits. In this country, water-mel- 
on seeds, owing to their hardness, and the mucilage which 
gives to them the greatest possible smoothness and liability to 
pass, are the most common ; but I have known other bodies, 
such as grains of Indian corn, shot, a small marble, and even 
small coins, to find their way through the same passage. 

The consequences of these accidents correspond with the 
character of the article, which thus finds its way into the 
wrong passage at the throat. A child four years old, lying on 
its back with a marble in its mouth, allowed it to pass sudden- 
ly down into the wind-pipe, and was strangled and destroyed 
in a moment. Bits of meat half chewed, have been known to 



FOREIGN BODIES IX THE WIND-PIPE OR LUNGS. 257 

produce an equally fatal result. But the body thus swallow- 
ed, is seldom of a figure and dimension to close the wind-pipe 
so perfect]}', as not to allow of breathing; the irritation of the 
bodv is however productive of great distress. Violent cough, 
wheezing, and sometimes acute inflammation follow ; but in 
other cases, the irritation is surprisingly small. I have known 
a water-melon seed to remain in the lungs of an elderly lady 
for more than a year, producing considerable cough and irri- 
tation, but no considerable disease, till at last in a violent fit 
of coughing, it was thrown up, very little changed. Grains of 
Indian corn have produced a greater degree of irritation ; but 
even these are sometimes borne for a great length of time, 
without producing any alarming symptoms. Where the ar- 
ticle thus drawn in is rough, the irritation it causes is greater, 
and cases of consumption have been attributed to such acci- 
dents. I visited a young lady within a few 7 days of death 
from consumption, who coughed up, within a week of her 
death, a little sprig of cedar which had produced so little ef- 
fect, when it was first drawn into the wind-pipe, that she had 
not disclosed the circumstance of having drawn it in. 

TREATMENT. 

When the accident has but just occurred, the body may be 
discharged bv a sudden and violent forcing out of the breath ; 
this should be attempted by the most violent voluntary efforts 
which can be made. If the body is heavy, great hope 
may be entertained by placing the windpipe with its upper 
portion downwards ; if it is a child, let it be held up by the feet. 
In some instances the body has but partially made its way into 
the wind-pipe and may be reached by thrusting the finger 
down the throat and withdrawing it. I have, in one instance, 
thus rescued a child from great peril in a moment. It had at- 
tempted to swallow a fibrous piece of beef, which I easily felt 
and removed with my finger. If the symptoms produced are 
mild, time should be taken, and various efforts to cause the ex- 
pulsion of the body by change of position and voluntary efforts, 
should be made. Nor should w T e be too precipitate in ordering 
a surgical operation for their removal. 

But we are not always allowed to choose our measures in 
these alarming cases ; suffocation is sometimes so great, and 
death apparently so liable to happen in a very short time, that 
the operation of perforating the wind-pipe for the extraction of 
the foreign body, becomes indispensible. This operation may 



288 FOREIGN BODIES IN THE WIND-PIPE OR LUNGS. 

sometimes be so absolutely necessary, that time cannot be ta- 
ken to obtain the service of a skilful surgeon ; it must be at- 
tempted by such as can be procured to undertake it. The 
operation is of itself exceedingly simple, and would be a mat- 
ter of no difficulty, but for the sudden motion of the part pro- 
duced by breathing and coughing. With the finger of the left 
hand pressed down on the wind-pipe immediately below its 
most prominent and hard point ; there will be felt a small pit 
or indentation, which should be aimed for by the cutting instru- 
ment. The incision need not be over an inch in length, and it 
should be carried on till the wind-pipe is opened. No pre- 
tender to the practice [of medicine should refuse to perform 
this operation, in a case of pressing necessity. 

The opening of the wind-pipe is not always attended with 
any relief, the body sought for being often far below the open- 
ing made. The orifice should be made sufficiently large to ad- 
mit of the escape of the body, should it be brought up ; and 
various contrivances have been made to prop, or hook open the 
new orifice. This being done, every effort must be made to 
cause the foreign body to escape. Try first a change of posi- 
tion — if it be a child hold it up by the feet — examine with a 
probe above and below, and hope that a timely and violent 
cough, will bring forth the thing sought for. In this way, [ saw 
a water-melon seed escape from the wind-pipe of an interest- 
ing child, on whom my friend Doctor B. A. White performed 
this operation. No exact rule can be laid down, for the meas- 
ures which shall be adopted where the operation is performed 
and the body found to have passed too far into the lungs, to ad- 
mit of its being reached. The orifice made by the operation 
should be kept open, in the hope that the efforts of nature, or 
the voluntary efforts of the patient, may in a favorable moment 
accomplish the object. A surgeon had performed this opera- 
tion for the removal of a grain of Indian corn, and failing in 
every effort to bring it forth, left his patient with the orifice 
open, that the efforts of nature might have no obstruction. 
Soon after he left his patient, a strolling quack happened to 
call at the house. Hearing what had happened, he persuad- 
ed the child to arise, and to place itself on its hands and feet, 
and canter like a horse a few paces, and leap over something, 
so as to alight on his hands, and make a violent effort to shout 
at the same time. At the first effort, the grain of corn fell on 
the floor ! ! 



PLEURi- 38 

INFLAMMATION OF THE LUNGS— PNEUMONIA. 

PLEURISY— PLEURIT1& 

titles, I have concluded to treat of disease? 
which have been divided by practical writers. The inflam- 
mation of the substance of the lungs, which is the dis 
known under the title Pneumonia, is perhaps more commonly 
met with than that inflammation confined to the external sur- 
face of the lungs, aud known as pleurisv. The distinction be- 
tween these two dis en under the stethoscopic ir- 
rigations of the day. is, to say the least of it, difficult- Nor do 
we derive, in a practical point of view, the benefit from these 
investigations which they might at first appear to pror.. 
The treatment of the disease in either form, is about the same; 
and it would be vain to attempt to make the distinctions be- 
tween them, manifest to the inexperienced practitioner. I 
have left for another chapter the inflammations met with in the 
trachea or wind-pipe, and a portion of its ramifications in the 

»s, because this disease, when extending to the throat, and 
frequently to the adjoining organs, appears in a form so differ- 
ent, as to require, many times, a different treatment. This 
part of the organs of respiration is, moreover, subject to the 
attacks of many disorders, in which the great volume of the 
lungs and their covering, appear very little to participate. 

Inflammation of the lun^s is a disease to which many per- 
are peculiarly liable, and in whom it is excited by any ir- 
regularity, especially exposure to cold. But the disease is fre- 
quently produced by an unseen and unknown cause, to which 
authors have found it nece particular term. I: 

is often epidemic. When the disease appears from this cause, 
the attacks of it have a peculiar character, one epidemic dif- 
fering as widely, in the character of the fever which attends ::. 
from another, as two diseases can well do. In one epidemic, 
:eet with a disease pre-eminently inflammatory, tending 
to the formation of matter in the lungs, either in its minute 

sels or in larger abs messes. This tendency is not always 
confined to the consumptive, in whom the suppuration of vomi- 
ca, or small abscesses frequently takes place. I have met with 
several instances of the formation of large abs ::om this 

cause, from which the patient has had a perfect recovery. 
without any manifestation of consumptive symptoms during the 
course of a long life. But in other epidemics, and by far the 
most formidable I have met with, the disease presents not the 
19 



290 PLEURISY. 

slightest tendency to the formation of pus, not the slightest dry- 
ness of the lungs and tenacious mucus, so characteristic of the 
inflammatory disease. On the contrary, the lungs in these ca- 
ses are overloaded with abundant secretions — many times in 
such quantity as to appear of themselves, the greatest cause of 
exhaustion. These distinctions in pneumonia are exceedingly 
important, because success in their treatment depends upon 
measures totally different, in one case from the other. 

DESCRIPTION. 

Our attention shall first be given to the highly inflammatory 
disease. In this, the attack is sometimes preceded by languor, 
heaviness, and slight pains in the back and head, similar to 
those which appear in the onset of most febrile diseases. These 
symptoms, however, seldom attract much notice. The patient 
yet continues to attend to his ordinary pursuits. The time at 
which the real attack takes place is manifest enough. A severe 
chill — sometimes the highest degree of chill — ushers in the dis- 
ease. On examination, the patient, though shaken with the 
disease and complaining of great cold, will be found with ex- 
tremities a little cold, the nose and face pale, but over the 
whole surface of the body a considerable degree of heat will 
already be manifest This state of things lasts sometimes for 
many hours — shivering continuing long after the fever becomes 
general. The fever becomes now manifest, the face flushed and 
tumid, the eyes swollen and watery, the heat of the surface 
considerable, and the pulse full and bounding. These symp- 
toms continue without abatement, for one day or more. To- 
wards morning, perhaps the second day, some remission of fe- 
ver takes place, but without perspiration, or other symptoms of 
the termination of the disease. A slight abatement only, will 
be noticed. The pulse undergoes a change which can be no- 
ticed by the experienced hand, but may perhaps be difficult to 
describe. Its volume is decidedly less, its beat quick and 
sharp, a special thrill as if there were a roughness to it, im- 
parted to the fingers — a state of the pulse frequently met with, 
whenever there is an important organ of the body affected with 
inflammation, which tends to suppuration. Great pain in the 
side, sometimes in both sides at once, in the region of the 
lungs, takes place from the first. This is a constant and troub- 
lesome symptom. It is true the lungs are sometimes inflamed, 
and suffer great damage without manifesting their disease by 
much pain ; but I think this never occurs in the disease we are 



PLEURISY. 291 

considering. If the lungs have an inflammation of this kind, it 
is during the presence of some other disease ; and when in this 
latent and unnoticed way, the dissector after death discovers 
that the lungs have been suffering a fatal lesion. Other symp- 
toms of serious disease present themselves. Delirium is not 
an unfrequent attendant, even in the first stage of pneumonia. 
This symptom, delirium, when it occurs in the first stage of the 
disease, may be regarded as an evidence of violence, but not 
of peculiar danger. Far different is it in the closing scene ; 
for as the disease approaches its termination, no symptom is 
more to be dreaded than delirium. Cough is a troublesome 
symptom of this disease, and is productive of much pain and 
annoyance to the patient. The character of this symptom de- 
pends upon the seat of the disease, and the present state of the 
secreted matter of the lungs, which is to be thrown off by 
coughing. Many times the sputor is so tenacious, that it is 
with great difficulty raised from the lungs, and even when it 
has reached the fauces, it is sometimes so glutinous, as to be 
with the greatest difficulty dislodged. When the secretions 
are more abundant, or when their character is so changed as to 
have freed them from this tenacious quality, the cough is only 
occasional, and the matter is thrown off without difficulty. 

The blood drawn in this disease has been long characterized 
by the term buffy, from its having a yellow pellicle over the top, 
when it has been allowed to stand and get cold. A cup-like for- 
mation of the coagulum is also observed. After a day, or per- 
haps less, the coagulum will be found to have withdrawn from 
the edges of the vessel, and its upper surface drawn into the 
form of a saucer. This state of the blood is, I think, uniformly 
present in cases tending to the formation of matter, either in 
abscesses, or in the minute vessel of the lungs. But on the 
onset of the disease — within twelve hours of its attack, even 
in the severest cases, the blood which flows, having a bright 
red color, will cool suddenly into a strong, firm coagulum, and 
present no appearance of buff on its surface. This appear- 
ance of the blood should not deceive us. It is an evidence 
even of a more intense degree of inflammation, than the buffy 
coat we have above spoken of. 

The expectoration is, at first, a transparent mucus. Soon, 
however, perhaps even the first day, it changes ; sometimes it 
is greenish, at other times of a rusty brown color, and this col- 
or is thought to be the most distinctive sign of inflammation of 
the substance of the lungs, properly termed pneumonia. As 
the disease progresses, if the termination is favorable, this deep 



292 PLEURISY. 

color fades away, and at last a yellowish matter, and finally a 
liofht colored mucus is alone discharged. These discharges 
from the lungs, be it remembered, are peculiar to the high in- 
flammatory disease, and do not belong to that which we shall 
presently consider under the term typhoid. During the pro- 
gress of the disease, the patient is unable to lie on the side 
most affected, he is commonly confined to his back. He will 
usually choose the position in which he can lie easiest, and 
thus lie breathing with great pain. The respirations are in- 
creased or hurried; and, in proportion to their shortness and 
suddenness, the danger has been thought to be great. To this, 
however, I have seen many exceptions. Such are the symp- 
toms of pneumonia during the first four or five days. 

After the fourth day, if the disease has not been arrested by 
timely and active treatment, the violence of the fever may be 
expected to abate. This abatement commonly happens at 
night, or early in the morning. Some degree of perspiration 
attends it. The expectoration becomes easier and the breath- 
ing less hurried; but in cases in which the disease is not giving 
way, all the symptoms at this stage will be rather aggravated. 
The expectoration will be still more difficult to accomplish, 
the breathing shorter, the pain not lessened, and there will be 
every appearance of great prostration of strength. The tongue, 
which in the first days of this complaint, is generally moist, 
rather enlarged, and covered with a light white fur, becomes 
dry, compressed, and is moved with difficulty. These symp- 
toms, as the prospect of recovery is greater or less, will be 
more or less considerable as the disease progresses. No re- 
markable change in them,, except in degree, need be expected 
till the disease reaches its termination. 

The time at which the disease will terminate is uncertain. 
Practical writers do not lead us to expect a recovery under 
twelve days. My own experience will give a shorter time by 
three or four days. But many cases are protracted even to 
twenty, or twenty-four days, in spite of any thing we are able 
to do. Some symptoms are noticed as peculiarly apt to occur 
at the period of the termination of the disease. A gentle, long 
continued perspiration, is perhaps the most favorable symptom 
which can occur. Some disorder of the bowels, a moderate 
degree of diarrhoea, is also considered a favorable symptom. 
But this is not to be relied on; for, in many instances, it is the 
reverse of a favorable indication. The urine, which, during 
the progress of the disease, has been pale, becomes highly col- 
ored, depositing a copious sediment of a reddish color, which 



PLEURISY. 293 

has been compared to brick dust. This symptom, I consider, 
one of the most favorable, The patient becomes sensible of 
his improvement. He is greatly relieved of pain, his breath' 
ing becomes more comfortable, is .less frequent, and his pulse 
becomes slower. Though there are cases in which the pulse 
continues considerably excited, and the breathing hurried to 
perhaps nearly twice as many times as in health, and yet the 
nt will recover — these symptoms giving wa} T very slowly, 
and after a length of time. 

Relapses are considered very common in this disease: and 
here too I have to remark, that relapses are not so common in 
epidemic pneumonia, as in cases which occur from the peculiar 
liability of individuals to this inflammation. Those, for in- 
stance, who have had the disease several times, should be 
above all things guarded against exposing themselves to the 
causes of a relapse. Nor is there in relapses, a very great dif- 
.ce from the original attack. The same symptoms will 
present themselves, and the same remedies, graduated in pro- 
portion to the strength of the patient, will be required. 

CAUSES. 

I have said that persons who have had pneumonia, some- 
limes become particularly liable to its attacks. This is so 
much so, that, in some cases, individuals have been known to 
have the disease once or twice a year, for twenty years togeth- 
Such persons will be liable to an attack, whenever an in- 
fluenza or common catarrh shall be epidemic. Other persons 
will be attacked with these diseases, and the individual allud- 
ed to, from the same cause will have an attack of pneumonia. 
The exciting causes, which are sufficiently powerful to produce 
the disease in those not pre-disposed to it, will, in the pre- 
disposed, most certainly bring it on. The most common of the 
exciting causes of pneumonia is cold — exposure to cold air or 
to rain. The danger is greater when the exposure is longest; 
the change from heat to cold for a very short time seems very 
little capable of producing this disease. The Russian experi- 
ences no injury from leaving his heated chamber, and plunging 
into the coldest water, or rolling in the snow, provided he re- 
turns in a very short time to his warm apartment. During the 
prevalence of the epidemic cause, which, as I have before 
stated, is unknown to us, a slight exposure seems, many times, 
to produce the disease, even in those not usually subject to it. 
This should be remembered by all persons, and special care 



294 PLEURISY. 

should be taken when this disease is prevalent, that no expos- 
ure to cold is continued for too great a length of time. Any 
cause affecting the lungs particularly, in a manner to produce 
pain, may also produce this disease. Breathing an impure at- 
mosphere, filled with dust, especially of a deleterious materi- 
al; speaking with great effort of the voice; inhaling poisonous 
vapors ; wounds, blows ; certain poisons taken internally ; the 
suppression of habitual discharges ; translation of disease from 
one organ to another, or any cause which might excite inflam- 
mation, may affect this organ as well as another. 

The season of the }^ear at which this disease appears, would 
seem to rob it in some decree of its title to be considered a dis- 
ease arising from an epidemic or unknown cause. The cases 
which occur in winter, especially late in winter and early in 
the spring, are far more numerous than those which occur at 
other seasons of the year. It never has appeared as an epi- 
demic, so far as I know, in the summer months ; nor has in- 
fluenza in this country. There is something therefore in the 
sensible qualities of the air, that pre-disposes to the occurrence 
of this disease. No investigation which has been made, has 
enabled us to point out the time at which the disorder ma} T be 
expected. T have passed whole years in a full practice, with- 
out witnessing a single case of pneumonia, except it might be 
in individuals, who from peculiar liability to it, took it from 
some occasional cause. Yet these years have presented noth- 
ing peculiar from which we might have inferred our escape 
from this disease. 

Pneumonia frequently appears during the progress of other 
diseases. It has always been considered a source of danger- 
ous complication. This happens most frequently from that 
inflammation of the trachea which has been termed bronchi- 
tis; and of this we shall treat in another place ; but it frequent- 
ly occurs in hooping-cough, influenza, small-pox, erysipelas, 
and sometimes after the performance of important surgical 
operations. All these complications suggest no alteration in the 
treatment of the disease, which is to be managed without much 
regard to these circumstances. No specific offers its kindly aid 
here. We are compelled to meet these difficulties as we find 
them; and our patients are obliged to endure the accumulated 
afflictions of the case. 

The danger which attends this disease, is always considera- 
ble ; and is to be judged of by the mildness or force of the 
S} r mptoms we have mentioned. Individuals who are peculiarly 
subject to it, have proved their capacity to rise from its infliction; 






PLEURISY. 295 

and, in such cases, the judgement to be formed is more favora- 
ble, than the s} 7 mptoms might seem to justify. The cases 
which arise from local injury, are far less dangerous under a 
given state of symptoms than others ; for the obvious reason 
that they arise from a mere inflammation, without any remote 
cause lingering in the constitution. Experience will soon give 
us a clue to the danger of the case before us. We shall soon 
find that the epidemic in which the diseases may occur, has a 
character of its own, and certain symptoms will be to us an 
evident signal of danger or safety. 

TREATMENT. 

From the earliest times, bloodletting has been considered 
the great remedy of pneumonia. A few heretics, as they have 
been called, have denied its beneficial effect. Of late, we have 
this subject reduced to statistics according to the spirit of the 
age ; and we have it set down in hospital reports, at what pe- 
riod of the disease bloodletting was resorted to, and how long 
the disease continued thereafter. This curious exhibition, as 
far as it has been tested, seems to shew that bloodletting shor- 
tens and renders less dangerous the disease, but we are still 
left in almost as much doubt as ever, as to the best manner 
and mode of using this remedy. One will advise you to open 
a vein in both arms at once, place your patient in an erect po- 
sition, and let the blood flow till he faints. Another will ad- 
vise that this harsh remedy shall be modified : that the patient 
shall be placed on his bed, and lose not more than forty ounces 
of blood. This operation they advise to be repeated daily, 
perhaps for several days. My opinion is, that the whole of this 
is sheer extravagance, and wholly unjustifiable in any case ; at 
least in this country. It should be recollected, that in the use 
of the lancet, it is not our sole reliance. I regard it as a great 
and valuable remedy, but never expect to so reduce the dis- 
ease by its use, as to require the administration of no other 
remedy. Much has been said in regard to the fainting which 
is a frequent consequence of bloodletting. My own opinion is, 
that this is the least reliable of all circumstances, as a guide to 
the quantity of blood which should be drawn. Some persons 
faint as soon as the flow of blood is experienced from the arm; 
while others would perhaps bear the loss of blood to the point 
of extreme danger, before this state would come on. My own 
rule is, to place my patient in a horizontal position, and to draw 
from the arm, by a medium orifice, the quantity of blood I 



296 PLEURISY. 

judge to be necessary — always making up my mind as to this 
quantity before the vein is opened. If the operation is per- 
formed on the first day of disease, and the patient be of full 
size, and of previous good health, and the attack at the same 
time violent, I do not hesitate to draw from eighteen to twenty- 
four ounces of blood. But this quantity is to be reduced 
wherever, the circumstances of the case, the debility, or small 
size of the patient, or any other obvious reason renders it ne- 
cessary, nor do I repeat this remedy as often as it will be found 
recommended in books. I resort to it a second time, on the 
second or third day, if I find the symptoms of the disease not 
mitigated. After this, if the disease becomes protracted un- 
der symptoms of peculiar inflammation, tending to suppura- 
tion such as I have described, I resort to small and repeated 
bleedings, regardless of the number of times the operation has 
been performed. I have seldom resorted to cups, or leeches, 
believing, as I do that there is no peculiar preference to the ex- 
traction of blood in this wav, and knowing that in taking it 
from the arm I have a perfect control of my remedy. I would 
add, that when I have known the remedy used in a manner 
differing from my own, I have had good reason to believe that 
the mode I pursue is the most successful. 

The next great remedy for pneumonia, is tartar emetic. 
This has been used in a manner still more extravagant than 
bloodletting. With the experience I have had of the use of 
this remedy, it is really hard to credit the statement of authors 
as to the quantity of tartar emetic they administer in cases of 
pneumonia. Grain doses, hourly, for thirty hours, appear to 
me enough to seal the doom of any man. Yet this is the boast- 
ed remedy of some great names. None of them, however, can 
have a higher opinion of its judicious use than I have. The 
mode in which I use tartar emetic is founded on the greatest cau- 
tion. The dangers which attend it when the dose has been too 
great, or the patient too weak to endure it, have been so appal- 
ling as to teach me caution. I make no attempt to press it on 
patients in a state of constant vomiting — so that their stomachs 
may at last learn as they say to tolerate it ; I should consider 
that an exceedingly hazardous experiment. 

Tartar emetic is to be used in the whole course of inflam- 
matory pneumonia ; or at least till suppuration, or the final 
resolution of the case has happened. In the first and second 
day, it should be prepared in the ordinary form of antimonial 
mixture, say two grains of tartar emetic and two drachms of 
nitre, in a half a pint of water. Of this mixture, give a table 



PLEURISY. 297 

spoonful hourly. If it produces no nausea or vomiting on the 
administration of the second or third dose, shorten the term to 
half an hour; but continue the remedy, as long as it can be en- 
dured without exciting vomiting. If vomiting occurs, it is all 
well ; but after it has occurred, the remedy should be suspend- 
ed for a time. This remedy will scarcely fail by this time to 
have reduced the pulse in its force, to have rendered pale the 
countenance which was before flushed, and perhaps to have 
bedewed the whole body with a mild and gentle perspiration. 
Such are the benign effects always to be derived from its ope- 
ration. Watchfulness of the changes which may now happen, 
is necessary. If the pulse again rises, and the face becomes 
flushed, and pain and difficulty of breathing grow worse, re- 
turn again to the antimonial mixture. It is to be continued un- 
der these circumstances throughout the whole course of the 
disease, and to be lessened in quantity as the symptoms mode- 
rate. When the remedy so used produces a cathartic opera- 
tion, it becomes necessary to suspend it. This is an unpleas- 
ant effect of this remedy, and, without due care, may render 
it unmnnageable or dangerous. Opium, in some form, should 
now be combined with it. Thirty or forty drops of laudanum, 
in a single dose, or ten drops in each dose of the mixture, may 
be used. By this means, having care not to press the anodyne 
too far, the antimony may be continued in almost every case to 
the desired extent. I consider it, when used in this way, a 
remedy far more efficacious in the removal of pneumonia than 
bloodletting. 

Mercury, in the form of calomel or blue pill, is an important 
remedy in this disease. It should be used after the second or 
third day, not to produce salivation, but in such a manner as 
to guard the bowels from the wasting, watery discharges, 
which antimonial s and cathartics too frequently bring on : and 
here let me remark, that in this disease all remedies which 
bring on fluid and watery discharges in quantity, do harm. I 
have seen the Greatest mischief result even from the use of 
Seidlitz powders. The effect of such remedies is to dry the 
lungs, to lessen the fluids of the body, and to render the ex- 
pectoration more difficult; and I have so often seen this result, 
that I am unable to doubt the truth of my observation. Calomel 
is, as a remedy, the very reverse of these wasting cathartics. 
It, on the contrary, promotes the discharge of matter which has 
in it a degree of solidity; and although the discharges pro- 
duced by it may be numerous, patients seldom seem to be pros- 
trated or weakened by it. At the same time, it seems to exert 



298 PLEURISY. 

a wonderful influence over the secretions of the lungs — chang- 
ing them from the dry, rough, adhesive matter which we have 
described, to that which is easily expelled by coughing, and at- 
tended with the greatest relief. The remedy comes in with 
the greatest advantage after three or four days, when by the 
use of active remedies the pulse is considerably reduced, and 
the patient placed in a state to admit of the administration of 
opium, in some form, at the same time. It is customary to 
combine calomel and morphine, or opium. I think myself, it is 
a matter of no consequence to combine them. I administer 
calomel at the rate of ten grains a day, in pills of two grains 
each, and make such occasional use of opium or laudanum, as 
the case may seem to require. The quantity of calomel to be 
administered cannot be perfectly defined. Some will think the 
quantity I have mentioned too minute. I myself sometimes 
give twice as much ; but I have never been able to satisfy my- 
self that the larger quantity was more effective for its particular 
ends, than the smaller. This is one of the peculiar qualities of 
calomel. It is seldom desirable to continue the use of it till 
salivation is brought on; I think I would treat a hundred cases 
in succession, without causing salivation in one of them. Ten, 
or even twenty grains of calomel given in one day, will very 
seldom produce salivation; the same quantity given in five or 
six days would almost certainly induce it. I therefore use 
calomel, one or two days, in an efficient manner, and then I 
make it a rule to suspend it for a time. I have never doubted 
that it was as successful, used in this way, as for the production 
of salivation. 

I have said nothing of this disease when occuring in infants. 
It is true, they are very subject to it — more, I have no doubt, 
than grown persons ; and it requires the best judgement, and 
most careful examination of the physician, to decide when this 
disease is present. The symptoms are the same with those in 
grown persons; the cough and fever are manifest, and the ten- 
derness which will be found on attempting to raise or move the 
child, will probably point out with sufficient plainness, the dis- 
order in hand. These cases, more than any other, require the 
use of calomel. It should be used in larger doses in propor- 
tion to the age, and longer protracted, for here the danger of 
salivation is far less, but in all other respects the treatment of 
this disease when it occurs in children, even of the earliest in- 
fancy, is just the same as when it occurs in grown persons. 

Opium is an exceedingly important remedy in this disease. 
It should be administered even on the first day, when the pain 






PLEURISY. 299 

or difficulty of breathing is intense. Let the patient be freely 
bled, and fifty or sixty drops of laudanum administered at 
the same time. The antimonial remedies which should im- 
mediately lollow, will lessen the force of its action with 
great certainty and success. This remedy, opium, is to be 
held in hand, and administered as the occasion may re- 
quire, during the whole progress of the disease. Let it be 
remembered that it is no specific, it removes no inflamma- 
tion ; it brings on no crisis, but is to be used for the removal of 
the distressing symptoms which may be present. As a general 
rule, I prefer it in divided doses, once or twice in twenty-four 
hours, say sixty drops of laudanum to a grown person. I should 
not hesitate to double the quantity when the symptoms were 
urgent. Under this view of the subject, with opium at the bed- 
side, not administered at the rising stage of fever, but in its 
decline, or after the use of antimonials, or other active reme- 
dies, it will be found a manageable and valuable means of les- 
sening the danger and the pain of pneumonia. 

Laxatives and cathartics are so much the hobby of the age, 
that we dare not omit them in the treatment of any disease, 
although in this case, they are referred to more to hinder the 
abuse than to direct the use of them. Active purgatives, espe- 
cially those denominated hydragogue, from their producing 
watery discharges, are always hurtful in pneumonia. The 
administration of the cathartic pills, vended in such abundance 
as quack nostrums, even before the physician is consulted, 
has done, within my observation, great mischief. Even phy- 
sicians will tell you that in this disease, the bowels must, to a 
certain degree, be kept active ; as they term it, they must be 
kept in a soluble state. This maxim I consider wholly wrong. 
The action of the bowels need not be greater than in health ; 
and when the disease is attended with prostration, it is far from 
being necessary that daily, or even second day, discharges 
from them should be had. A moderate degree of costiveness, 
even extended to four or five days, without an evacuation, has 
never, in my practice, seemed to be productive of particular 
mischief ; while one or two active discharges, from any reme- 
dy, have always proved injurious. If, from the total inactivity 
of the bowels, a discharge from them should be deemed ne- 
cessary, there will be no danger in the administration of a dose 
of castor oil ; but the calomel used as above recommended, 
will almost always of itself be sufficient. I think it unneces- 
sary to dwell longer on the subject of cathartics in this disase. 
Use them sparingly ; but do not abuse them. 



300 PLEURISY. 

Medicines producing perspiration, have been much used in 
pneumonia. The antimonials which I have recommended, 
effect this purpose in the way most beneficial. There are not, 
however, wanting, cases in which this remedy fails to produce 
the slightest perspiration. When this happens, the best reme- 
dy is unquestionably opium, and it is to be governed by the 
principles already explained. Beyond this it is not necessary 
to go in our efforts to induce perspiration, and the subject is 
alluded to, more that the use of the numerous stimulating teas 
and infusions which will be offered in these cases, should be 
avoided, than for any other cause. They are, in general, use- 
less or hurtful. 

Counter irritants, such as mustard, blisters, and others have 
been much used in this disease. I think their use requires re- 
striction. To me it appears, that the application of mustard 
over an inflamed organ, during a high state of fever, and when 
that organ is in an intense state of inflammation, can hardly do 
good. True, it seems sometimes to give relief from pain ; but 
I have observed that the relief is of very short continuance; 
that it is scarcely more than atoned for by the pain of the ap- 
plication ; and that the symptoms of the disease, are not bet- 
tered by it. I therefore object to these remedies during the 
continuance of the high state of fever, and while the skin is 
parched and dry. When this stage of the disease has passed, 
and the skin becomes moist, the application of mustard in parts 
contiguous to great pain, is beneficial. It may be resorted to 
when pain suddenly succeeds to ease, and the patient is thrown 
into great agony at the time. It should not be continued to the 
formation of a blister, but removed when the skin has become 
thoroughly red, and by no means continued after a yellowish 
and shrivelled appearance begins to take place. When the 
extremities are cold in the declining state of the disease, and 
the patient is struggling in a doubtful state, these remedies 
become more useful. They may be applied to the extremi- 
ties, from time to time, as the occasion may seem to demand. 
For blisters I have a much greater regard. They are, if prop- 
erly used, generally beneficial, and sometimes I have no doubt 
exceedingly important. They should not be applied in the 
commencement of the disease, but at the time designated by 
Doctor Rush, as the blistering point ; that is, when the skin 
has, from the use of other remedies in the progress of the dis- 
ease, become moist. Used before this time, they produce a 
great deal of unnecessary pain and excitement, and instead of 
being filled with a thin watery fluid, they are puffed up with a 



TLEURISY 



301 



thick jelly, which will not flow when the epidermis is cut. 
Such blisters dry up immediately ; but if the application is 
delayed until the skin becomes moist, they fill with a thin se- 
rum, and continue to run for many days. I have no doubt 
they lessen the inflammation in the neighboring organ, and it 
is certain that they often relieve the severest pain. There is 
no case in which I have used this remedy with more satisfac- 
tion, than in pneumonia. Where the disease is protracted, 
and the lungs especially in danger of suppuration, it seems to 
me dangerous to dispense with them. A great many articles 
besides these might be mentioned as producing a counter irri- 
tation ; but I believe there is no advantage in any of them 
which may not be obtained by those I have mentioned. 

Medicines which are supposed to increase expectoration, 
have had a great run in the treatment of this disease. They 
are of acknowledged uncertainty in their effect. A great many 
that have been used uuder this title, would be pernicious du- 
ring a state of inflammation like that of pneumonia ; and, ex- 
cept the antimonial and mercurial remedies already referred 
to, I have none of this class to recommend. 

The closing stage of this disease, presents us with our pa- 
tient sinking into the arms of death, or rising towards recovery. 
Little need be said of the means of support, when in the awful 
condition first alluded to : but where the case is terminating 
favorably — where the expectoration has become sufficiently 
easy, the pain subsided, and the fever almost gone, the pros- 
tration of strength calls for some means of support. Generous 
food, introduced according to the strength of the patient, forms 
the surest and most uniformly proper means. But the tonic 
medicines, and indeed the powerful stimulants sometimes rec- 
commended, find their places here, as well as in other cases of 
debility. Wine, in moderate quantity, may be used once or 
twice a day in the beginning, continued as long as it is found 
necessary, and then suspended. Pure spirit may be used in 
the same way, and in some respects, I have thought it the best 
article. Where the patient has been extremely low, and the 
recovery previously slow, tonic medicines, vegetable bitters, 
preparations of iron, elixir of vitriol, and other remedies of 
this class, used according to the urgency of the case, will be 
proper. 



302 TYPHOID PNEUMONIA. 



TYPHOID PNEUMONIA— PNEUMONIA TYPHOIDES. 

This form of pneumonia has been long known to medical 
writers, but treated of under so many titles, seen in so many 
varieties, and combatted with such different remedies, that it 
becomes difficult or impossible to recognise it in the various 
treatises which have referred to it. It is not strange that pneu- 
monia should sometimes be accompanied with a fever of a low 
or typhoid grade, as well as inflammations of the intestines, 
or other organs having mucous surfaces. Why it should 
at one time be attended with a fever of a stringent and. 
highly inflammatory kind, and at another time with a dis- 
ease of an entirely opposite character, we shall, in the pres- 
ent state of our knowledge, vainly enquire. I have separated 
this part of the subject from that which has been presented 
above, for the purpose of making it as perspicuous as I can. 
Every one will confess that in the books heretofore published, 
the subject is far from having been analyzed, or discussed in a 
manner suited to the wants of the student. 

Typhoid pneumonia presents itself in many forms, and un- 
der various circumstances. It sometimes occurs in individual 
cases, unconnected with any particular state of the atmos- 
phere, or epidemic tendency to disease. It is rare, to meet 
with two cases about the same time, exhibiting different states 
of febrile action. If a highly inflammatory case presents itself, 
it will be rare, within a few days, to find another of a different 
character. Yet it is true, that the disease sometimes makes 
its onset with symptoms highly inflammatory ; soon termina- 
ting, however, in the typhoid prostration which we are about to 
consider. No disease requires, therefore, more watchfulness 
in its treatment ; for the physician who prescribes correctly 
for the symptoms to-day, may find a similar remedy to-mor- 
row, wholly inapplicable. In addition to the title under which 
we are treating of this disease, we shall be obliged to recog- 
nise it in the accounts given of it by others, under the titles 
" Cold Plague," " Pneumonia Notho," " Typhus Pleurisy," 
*• Bilious Pleurisy," and perhaps many others. As an epi- 
demic, this disease was first recognised in South Carolina, 
about the year 1815. The spotted fever of the Northern 
States, which had preceded it in point of time, has been 
thought by some to be the same disease. I have, however, no 
sufficient evidence of that fact ; but incline to the belief, that 



TYPHOID PXEUMOXIA. 303 

it is identical with the typhoid fever, of which, for many centu- 
. we have regular records, in all the countr: nich 

medicine has been a science. Typhoid pneumonia is, as I 
think, a different disease. In South Carolina, it put on a fear- 
ful degree of malignity. I well rr:nember the startling ac- 
counts, with which it was heralded, in the newspapers. It 
s not till the year ISIS, that it made its appearance in 
Milledgeville. T »V were prepared to expect it, and with the 
opening of winter, we soon made this new acquaintance. I 
shall not soon forget the first case in which I witnessed its 
power. I was called to a servant girl about ten years of age, 
who it was represented had been attacked an hour or two be- 
fore. She was apparently in a deep sleep, and could not be 
aroused to notice ar. her extremities cold, breathing 

heavy, and rather snoring. Her pulse not very rapid, was so 
soft that it did not make the slightest resistance on pressure, 
s not prepared to pronounce it a case of the expected epi- 
demic, or cold plague, and was wholly at a loss to account for 
the situation of my patient. It was not long since I had heard 
the eloquence of Doctor Rush, describing the power of the lan- 
cet to bring forth excitement, from a sudden prostration like 
that before me — to raise the pulse, and to restore the powers 
of nature when they appeared to be lost. Uncertain what 
course to pursue, I corded the arm of my patient, opened a 
vein and drew from it about an ounce of blood. It flowed 
drop by drop, the circulation being insufficient to afford it 
more rapidly. It was dark, and showed no tendency to co- 
agulate, but remained fluid in the cup in which it was drawn. 
Binding up the arm, I proceeded in search of a remedy, still 
uncertain what course it would be proper to pursue. I deci- 
ded, however, to administer a diffusible stimulant of great 
power, and soon returned with such a one in my hand. I 
found my patient wholly unable to swallow, and she expired 
in three or four hours. Such was my introduction to epidemic 
typhus pneumonia, or cold plague. 

The Jisease soon spread at a fearful rate. Man* ore- 

sented themselves in two or three days, but they were com- 
paratively mild, and the mortality which attended them did 
not prove to be great. I am not prepared to think that the 
disease will present itself in the form I then witnessed it, in a 
great many places. The disease described under the titles 
u Bilious Pleurisy," " Typhoid Pneumonia," &c, differs con- 
siderably from that I witnessed in ISIS. Yet it will be my du- 
ty to describe it as I saw it. And I will here premise that the 



304 TYPHOID TNEUMONIA. 

disease, as I saw it in that year, was, from that time, epidem- 
ic, several winters in this section of the country. It has not of 
late presented itself so frequently ; but I have met with it al- 
most every year since. 

Like the inflammatory pneumonia, this disease is usually 
ushered in by a chill. The shivering and uneasiness felt by 
the patient is probably less, but the actual coldness of the flesh 
is much greater. The pulse also, in extreme cases, is easily 
recognised, full, frequent, soft — soft as air on the finger. Un- 
der the slightest pressure, it can scarcely be felt at all. Pain in 
the head is a very common attendant, even at this time. De- 
lirium so uncommon, at this stage in other forms of the dis- 
ease, is frequently present. The chill, however, gradually 
subsides, and a fever, with increased circulation, takes place. 
The characteristic pain of the lungs will also now make its ap- 
pearance. But the breathing, although oppressed and labo- 
rious, does not appear to be attended with as keen pain, as in 
the other variety of this disease. Other pains are frequently 
present, and, in some instances, a pain in a part apparently 
not qualified to affect life, seems to form the most violent part 
of the disease. A pain in the knee, in the shoulder, in the 
back, or indeed in almost any part of the body, sometimes 
comes on with a suddenness and violence almost insupporta- 
ble. When the affection of the head assumes its worst form, 
producing delirium and coma, all other symptoms are lost 
sight of, and the patient frequently dies, apparently with in- 
flammation of the brain. These are the cases, termed in the 
country, "head pleurisy." 

Perhaps the most characteristic symptom in this disease, is 
the state of the lungs. The cough is as violent as in other 
cases ; but the mucous secretions from the lungs, are abun- 
dant. I have seen them more copious in this, than in any 
other disease. At first a ropy fluid is freely thrown off, re- 
sembling the white of an egg, a little beaten. Soon its tint is 
changed ; a light claret color is observed in it, not in streaks 
of blood, or in a rusty dark color, as in inflammatory pneumo- 
nia, but thoroughly mingled through the whole, presenting a 
uniform claret colored fluid. I have seen such fluid discharg- 
ed in mouthfuls, so that in less than two hours, a pint would 
be discharged. And this symptom I have seen, not in one or 
two, but in many cases. Where the disease is less violent, and 
the bloody exudation does not present itself, a colorless fluid 
continues to be discharged. But this also is sufficiently copious 
and the patient, although exceedingly worried with the effect, 



TYPHOID PNEUMONIA. 305 

-mpelled to throw it off very frequently. This state of the 
retions from the lungs, does not run into the formation of 
thicker, and higher colored matter ; but when the case termi- 
nates favorably, it gradually disappears, so that the patient is 
by degrees relieved from it. The prostration of strength 
which attends these attacks, is as great as in any other disor- 
der. Within a few hours the patient may be unable to rise 
from his bed. Such is the cold plague, as I have seen it. 

In the epidemic to which I have referred, there would have 
been no propriety in the term, bilious pleurisy. The disease 
presented no symptoms of superabundant bile ; but there can 
be no question that a disease of kindred character is often met 
with, in which the symptoms of diseased liver, and disorder of 
the biliary funtions are present. These cases appear, in the 
outset, to affect the stomach with great nausea and vomiting. 
The e}-es become yellow, as in jaundice, and the urine of a 
corresponding color. Some pain in the region of the liver is 
felt, and the disease rather disposed to assume a chronic form, 
runs frequently into a very low typhus fever. There are other 
cases in which the same symptoms occur, with the exception 
of those which I have referred to the liver. The fever as- 
sumes a lower grade ; the pulse, although apparently full, is 
never tense ; the pain of the lungs is far from being as acute 
as in the truly inflammatory disease. Blood from the arm co- 
agulates, with a bluish serum floating over it. But the buffy- 
coat, and firm coagulum are wanting. The state of the mouth 
and tongue, also correspond more with typhus fever. In the 
early stage, the tongue is shrivelled and dry ; a brown fur is 
found on it after a few days ; and in this shrunken form, it is 
not under the command of the patient. A dark sordes collects 
around the teeth and the breath becomes exceedingly offen- 
sive — a taint which experience will readily recognise as that 
which is found in the last stage of typhus fever. 

Few points in the practice of medicine, are of more impor- 
tance than the discrimination between the highly inflammato- 
ry, and typhoid attacks of pneumonia. Their symptoms, al- 
though greatly resembling, have in them a difference which 
may be recognised, and that difference should be closely scru- 
tinized. I have attempted to point out the differences which 
are most obvious. I think it proper to repeat them here. In 
the pulse of the inflammatory disease, we find violence and 
tension, or great strength — in the typhoid the reverse. The 
lungs in the inflammatory disease, secrete but little ; they are 
dry. In the typhoid, they are never dry ; although, from ex- 
20 



306 TYPHOID PNEUMONIA. 

treme debility, patients are sometimes seen to labor hard, and 
in vain, to throw off the mucus with which the lungs are load- 
ed. The prostration of strength of the first day, may be con- 
sidered characteristic of the typhus disease ; and it is always 
to be remembered, that the disease which commences its ca- 
reer with all the inflammatory symptoms, may nevertheless, 
run down to the lowest typhus form. 

A word or two in regard to the cause of this form of pneu- 
monia. I have said that when epidemic, it depends upon a 
cause wholly unknown. We meet it as it is, and cannot as- 
sign for it any cause. But, in many instances, it occurs in in- 
dividuals from causes which appear to be occasional, such as 
exposure to cold, and from the peculiar state in which they are 
found, it assumes a typhus character. I have no doubt that 
many persons who have, from repeated attacks of bilious fe- 
ver, or chill and fever, become diseased in all their viscera, 
are particularly liable to this disease. I believe it is far more 
common in those regions which are denominated in this coun- 
try, " sickly," than in others ; because there it meets with in- 
dividuals whose health is exactly suited to its production. Au- 
thors have remarked, that this disease is generally attended 
with a lingering recovery. This I think is not the case, ex-* 
cept with persons who were previously indisposed, with liver 
and spleen more or less inflamed, and perhaps all their diges 
tive functions in a state of disorder. 

TREATMENT. 

When this disease occurs from an epidemic cause, and with- 
out the bilious symptoms to which we have referred, and when 
the symptoms are attended with the prostration I have de- 
scribed ; and this is the case in most of the dangerous cases, 
I have no hesitation in using immediately the most powerful 
stimulants. I combine for this purpose three grains of opium, 
and ten of camphor into three powders, and administer one of 
them hourty, till the whole are taken. If a copious perspira- 
tion is brought on, and the patient relieved of pain, I consider 
him almost entirely safe. He is not, however, to be abandon- 
ed ; but the same remedy repeated, from time to time, after- 
wards whenever the skin becomes dry, and he becomes a lit- 
tle restless. This course is to be pursued for two or three 
days, when stimulants and tonics may be combined in the 
treatment. The old remedy, bark and snake root in infusion, 
which we used in 1818, is probably entitled to its place still. 



TYPHOID PXEUMOXIA. 

inly I was then well satisfied with its effects ; and I fa 
it, from time to time, from that day to this. I have had 
t prepared in the following way. Take of Peruvian bark two 
ounces, black snakeroot half an ounce ; pour on them a quart 
)f boiling water, and set the vessel near the fire till well drawn. 
Two ounces, or a common wine glass full of this infu 
o be given at a dose. It may be repeated every two hours, 
>r less frequently, according to the judgment of the practition- 
Laudanum, in such doses as the ems to require, 

houid be added — from sixty to one hundred drops in the 
course of the day. In cases of the most acute character, 
here, in its natural course, the disease would run to its ter- 
mination in three or four days. I have found it unnecessary to 
:ny other remedies but these. At the close of the treat- 
nent, when the symptoms of the disease have nearly disap- 
>eared, a judicious use of spirit and water, or toddy, once or 
. may be resorted to. 
Where the disease is protracted beyond the fifth or sixth 
. or where, at an earlier day, the symptoms of local dis- 
in the lungs and liver are prominent, calomel should be 
:ted to. It should be administered in combination with 
opium or laudanum, and doses of from two to five grains, may 
be repeated three or four times a day. Id these ease 
after the use of calomel, it seems proper to continue the use of 
k and snakeroot. There will be little benefit in changing 
this for other vegetable tonics, or bitters : but if the bark were 
not at baud, I would not hesitate to substitute gentian, or even 
wild cherry-tree bark, or any other convenient vegetable bit- 
Other stimulants also are equally allowable, and may 
resorted to, if those I have mentioned are not within reach. 
In the form of this disease which has been termed bilious, 
great deal has been said in favor of emetics. I have made 
little use of them, but should not hesitate in the event of 
stomach's proving irritable to give ipecac, or any mild 
metic. I should by no means venture on tartar emetic, for 
lis form of the disease, I have seen it produce copious, 
-:ing, watery discharges, requiring to be arrested by the 
most powerful opiates. 

Bloodletting, which would seem to be indicated from the 
oppressed state of the lungs, is, in most cases, wholly inad- 
sible : yet I have, in a few cases, resorted to it, with very 
sfac Where I have found the skin of my pa- 

tient dry, the pulse full, although not hard, the cough exceed- 
ae, and the breathing short and hurried. I 



308 DISEASES OF THE HEART. 

have not hesitated to draw from the arm a reasonable portion 
of blood. I have always followed it instantly with large do- 
ses of opium, and other stimulants, not dreading even the use 
of spirits in such cases. Beyond this, I have not ventured on 
the use of the lancet. Indeed the cases in w hich I have seen 
it used in the hands of others, have not given me reason to 
change my course. Much has been said in favor of the volatile 
alkali, as a stimulant in these cases. I have not much expe- 
rience of its use, but should not hesitate to substitute it for cam- 
phor. It should never induce the neglect of opium, which I 
think by far the most important remedy in this disease. To- 
wards the close of the disease, the sulphate of quinine, now 
universally used in place of the Peruvian bark, may find its 
place in the treatment. In many instances, it might not be 
practicable to procure either the Peruvian bark in substance, 
or the snakeroot. In such cases let the sulphate of quinine be 
substituted. Doses of two grains may be repeated five or six 
times in twenty-four hours. If the case is acute, and seems to 
be running rapidly to a crisis, larger doses may be administer- 
ed. 1 should not hesitate to give fifteen or twenty grains in 
twenty-four hours ; but this is not, by any means, to be con- 
tinued more than one or two days. The mischiefs which have 
resulted from the protracted use of heavy doses of quinine, 
should not be forgotten in this, or any other disease. 

Relapses are thought to happen oftener in this, than any 
other form of pneumonia. This, in my opinion, applies only 
to the feeble and disordered persons who happen to be attack- 
ed by it. They should be sedulously guarded against all cau- 
ses of relapse. They should be clothed in flannel ; and should 
avoid all exposure to dampness and cold. 



DISEASES OF THE HEART. 

There are few things in which I take less pleasure, than the 
study of incurable diseases. For a long time, the affections of 
the heart were comparatively little noticed. The dissector of 
dead bodies, could not fail, in many instances, to find that it 
had been diseased ; but the faint hope that remedies might be 
useful in such diseases, gave to their investigation, a discour- 
aging rather than an inviting aspect. A new spirit has arisen 
in the medical world, and the diseases which promised the 
least reward for their investigation, are now studied with the 



DISEASES OF THE HEART. 309 

nost labor; those of the heart especially, since the use of aus- 
cultation, have become a matter of much greater interest. Still 
heir study seems to be quite unpromising, and I shall satisfy 
nyself with writing concerning them, a very short essay. 

The heart is composed of muscular and tendinous matter. 
The muscles are of all parts of the body the least subject to dis- 
ease ; but the tendinous or fibrous matter cannot boast of equal 
exemption. The diseases of the heart are, therefore, mostly 
seated in its valves and tendons; which are particularly sub- 
ect to inflammation ; and late observation seems to prove, that 
■ :hey are not an unfrequent seat of rheumatism. Inflamma- 
:ory diseases of this description, are certainly a fair subject of 
medical treatment, and form a class o\^ diseases of the heart 
well worthy of investigation. 

Every one should know, that in the heart lies a particular 
power, which is excited in the circulation of the blood ; that 
this organ is in fact a compound forcing pump, receiving into 
its two chambers, at its dilatations, the blood from all parts of 
the body; and, at its contractions, throwing forth this fluid 
with great violence through the lungs, from one chamber, and 
through the whole system, from the other. That a muscular 
effort so powerful should be performed at every pulsation, 
.averaging perhaps seventy for each minute for a long life, is 
the crowning wonder in the structure of man. The muscular 
fibres which perform this contraction, are as I have said, a tissue 
of the body very little subject to disease. In this organ, how- 
ever, they undergo great changes, some of which are the re- 
sult of their own diseases, but others the consequence of those 
of other organs. The particular changes noticed, have been, 
on the one hand, a softening, thinning, and finally bursting of a 
chamber of the heart; on the other hand, a thickening and aug- 
mentation of volume, and strength, equally remarkable. 

HYPERTROPHY. 

The heart, in a healthy state, is about the size of the clench- 
; ed fist of the owner — in men, its weight is from eight to nine 
ounces ; in. women, something less. In hypertrophy, the di- 
mensions and weight of this organ are increased; its bulk and 
: its strength are frequently three times, perhaps more than 
twice three times, their proper size and strength. This in- 
1 crease in the size and weight of the heart, is not always a proof 
. that the heart itself is diseased. Every muscle of the body 
\ increases in volume, when its contractions are habitually in- 



310 DISEASES OF THE HEART. 

creased ; and this law applies with equal force to the heart 
When the circulation of the blood is impeded by the contrac 
tion of the arteries that lead from the heart, by diseases in its 
valves, by the pressure of tumours in other organs, hindering 
the passage of the blood in the arteries, or anything in fact 
which can give to the heart the necessity of more powerful 
contraction, to empty itself of its contents. The organ will, 
by this law of nature, gradually acquire force to perform its 
office, with a corresponding thickening and increase of its 
muscular tissue. This cannot properly be called a disease of 
the heart ; it is rather an instance of the patch-work which 
nature, in so many instances, performs, by compensating for 
the imperfect action of one organ, by an increase of power in 
another. This disorder of the heart is oftenest found in its left, 
or largest ventricle. It is, however, sometimes present in the 
right ; less frequently it is connected with a giving way, and 
finally bursting of the heart in aneurism. Now it is obvious, 
that in all these cases, we shall seldom be able to point out a 
successful remedy ; they are to be borne to the end, with such 
slight benefits as the avoidance of any excitement, perfect reg- 
ularity of life, and habit and a strict regard to temperance, can 
give. 

A great deal has been said of the light thrown on the dis- 
eases of the heart by auscultation, or listening to its sounds ; 
and I have no doubt that a great deal may be known of the 
situation of this organ, by this means. The utility of such 
knowledge when acquired, is the difficulty, and the doubt. I 
have no belief that any account I could give of the tedious in- 
vestigations which have been advised, would be of much bene- 
fit. I have not resorted to them myself, but have been con- 
tent to make my prescriptions from the study of the general 
symptoms, which I shall proceed to describe. 

The heart is seldom much diseased without manifesting it, 
by obvious symptoms. The disorder its diseases produce in 
the circulation, is first noticed. On feeling the pulse at the 
wrist, great irregularities will be felt in it; but these irregulari- 
ties vary indefinitely. Most commonly there are several quick 
pulsations in succession, followed by an interval of more or 
less length. On placing the hand on the breast, the motions of 
the heart will be found to correspond with the pulsations at the 
wrist. If the disease has produced much alteration in the 
volume and position of the heart, that alteration will be obvi- 
ous enough on the examination. Almost always the pulsations 
will be felt over a much more extended 'surface, than thev ex- 



DISEASES OF THE HEART. 311 

tend to, when the organ is in health. In some instances, the' 
whole breast, on both sides, seems to be occupied with an 
enormous palpitating and fluttering heart. These attacks of 
palpitation are at first not very frequent, and soon pass off, 
leaving the circulation very much as it was before the attack. 
But as the disease progresses, the attacks become more fre- 
quent ; and, at last, the circulation ceases at any time to be 
healthy. 

These symptoms do not always indicate a chronic disease of 
the heart ; they arise, in many instances, from a peculiarity in 
the nervous constitution, which has so far eluded the scrutiny 
of the pathologist. These cases we have been obliged to sat- 
isfy ourselves with denominating nervous ; and they have been 
thought to present themselves most frequently in individuals of 
the softer sex ; but I am far from being certain, that this opin- 
ion has a sure foundation in nature ; I have about as often met 
the disease in one sex, as in the other. 

In nervous temperaments, palpitation of the heart is often 
brought on by things operating on the digestive functions. Food 
which produces a fit of indigestion, will often bring on an at- 
tack of palpitation ; in other instances, tea or coffee seems to 
produce the same effect. 

Diseases of the liver have been long celebrated, for the in- 
fluence the}?- exert over the functions of the heart. Every one 
who has had much experience in the treatment of the disorders 
of this organ, wdiich follow the autumnal diseases of a Southern 
climate, will recollect the cadaverous looks, throbing hearts, 
and violent motion in the arteries of the necks, of such patients. 
These symptoms are without interval; but the cases present 
many instances of the most painful palpitation, from time to 
time. Great depression of spirits attends this state of health; 
and the brain itself is frequently, in the end, involved in the 
disorder. 

Pain is an exceedingly uncertain symptom of the diseases of 
the heart. In some instances, it is exceedingly distressing, and 
almost always present; in others, the sensation experienced 
by the patient, is one of oppresssion and discomfort, rather 
than pain ; but there are other cases still, in which there are 
attacks of pain, extending along the main arteries down the 
arms, with a violence too great to be borne. 

Now, in all these diseases of the heart, there is an obscurity, 
which justifies a great distrust in the opinions formed of their 
nature. It is true that when, from any cause, the volume of 
the heart becomes greatly enlarged, that fact can be almost cer- 



312 DISEASES OF THE HEART. 

tainly ascertained. But in the minor diseases of this organ, 
where its office is performed without very great irregularity, 
the question whether it is a nervous, or functional disorder, or 
arises from some structural derangement of the heart itself, 
will remain uncertain. But this uncertainty is a less evil than 
it might at first appear ; for the remedies which it will be ne- 
cessary to administer, will be decided by the state and condi- 
tion of the general health of the patient. 

PARTICULAR DISEASES OF THE HEART. 

Although our knowledge of this subject is so limited, it is al- 
most impossible to treat of it without dividing it into several 
heads. Simple rrypertroprry is thought to be a very common 
disorder ; it consists in an enlargment and thickening of the 
walls of the heart ; and in what degree it shall exist before it 
is pronounced a disease, is a matter of question. Every mus- 
cle in the body, when subjected to great, protracted, and often 
repeated effort, becomes enlarged, or hypertrophied. Some 
degree of enlargement of the heart, is believed often to result 
from the simple effect of violent labor, throwing into it a vast 
amount of blood, and producing thus a great increase of the 
circulation. Mental effort is said to produce the same effect \ 
and I have had occasion to observe in more than one instance, 
that my patients, when affected with these disorders, were to- 
tally incapacitated for mental application. So soon as. the 
heart has acquired a considerable increase of power, its mo- 
tions become more obvious, and the patient becomes sensible 
to every pulsation. The blood is thrown with too much vio- 
lence into many organs, and congestion of the brain, hemor- 
rhage from the lungs, and other alarming symptoms, sometimes 
supervene. The complexion is not rendered pale and cadave- 
rous from disorders affecting the heart alone. On the contra- 
ry, the blood is frequently seen flushing and crimsoning the 
face, while all the symptoms of suffusion and over-fulness of 
all the vessels, are obviously present. The heart, in the mean 
time, progresses in its developement ; it grows still larger, and 
becomes oppressive to the other organs contained in the chest. 

These cases, when the}'- arise without organic derangement 
of the blood-vessels which arise in the heart, are fair subjects 
of medical treatment ; and, in many instances, admit of a per- 
fect cure. The volume of blood must be reduced ; and this is 
to be done, not only by remedies, but by a very rigid and low 
regimen. It would be useless to enter into the details of treat- 
ment, in such a case. Ever} 7 cause of excitement should be 






DISEASES OF THE HEART. 313 

carefully avoided ; food should be taken in limited quantity, 
and of the least stimulating kinds. If the pulse does not give 
way, and the circulation become more uniform, bloodletting 
and mild cathartics should be used ; and these remedies should 
be continued, with an energy and perseverance suited to the 
importance of the case. 

Other cases of hypertrophy, arise from mechanical obstacles 
to the circulation of the blood; the heart being compelled to emp- 
ty itself at every pulsation, increases in strength in proportion 
to the resistance it meets with. The obstacles to the cir- 
culation are seldom such as admit of removal, by the use of 
remedies. Some respite from pain, some relief from suffering, 
and some mitigation of danger, may arise from the treatment 
I have recommended above ; but no recovery is to be ex- 
pected. 

There are yet other states of enlargement of the heart, 
which we are bound to contemplate, although they are of rare 
occurrence. The heart cannot always resist the force brought 
against it; its walls sometimes gradually give way, the organ 
becomes enormously large, while its walls become thin, at 
some points, and thick at others; the whole chest is, as it 
were, lull of heart ; and, in some instances, post mortem ex- 
aminations have shown the dimensions of this organ to equal 
that of the largest bullock. In this state of things, nothing can 
be hoped from remedies, but a temporary alleviation from suf- 
fering. It is useless to say more. Since every motion, every 
effort, must be made with the danger of instant death, quiet- 
ness of mind, and stillness of body are about as much as can 
be recommended. 

ANGINA PECTORIS. 

Like other diseases of the heart, this has no common name; 
it is fortunately of such rare occurrence, that the great com- 
munity of men has not found a name for it necessary. Its at- 
tack usually takes place suddenly, and without warning ; the 
patient may be walking, especially up-hill ; he is seized with 
pain in the region of the heart, with a sensation that resembles 
strangling. He stops suddenly in his course, supports himself 
by any thing he can lay hold of, and waits in horror the result. 
Pale and haggard as death, he still breathes without particular 
difficulty ; and, if the attack is not fatal, the pain is soon over, 
and he may resume his walk again. Months may elapse be- 
fore he is attacked aoriin ; but it is almost sure to return, and 
when it does, its violence is increased. The disease occurs 



314 DISEASES OF THE HEART. 

more frequently in men than in women. Several attacks may 
be survived ; but, in the end, it will be fatal. The exact state 
of the heart which gives rise to this disease, is, I believe, but 
little understood ; its treatment is therefore obscure. It has 
been advised to treat with moderately stimulating remedies, 
avoid the exciting cause of the disease, and trust to Providence 
for the rest. 

INFLAMMATION OF THE HEART. 

The heart and its investing membrane are subject to inflam- 
mation. This inflammation is not apt to extend to the muscu- 
lar fibres ; but confines itself to the membraneous portions of 
the heart, sometimes extending to the whole, but in other in- 
stances, it is more limited. It is difficult to distinguish be- 
tween the varieties which may exist in this disease. It is in 
all cases a dangerous disorder. When it affects the pericar- 
dium, or sack containing the heart, it frequently results in a 
local dropsy of the organ ; in other cases, adhesion takes place 
producing fatal impediments to the motions of the heart. 

The symptoms which attend this disease, are from the first 
alarming. The expression of the countenance is peculiar, and 
distressing ; palpitation of the heart, oppression at the pit of 
the stomach, pain, inability to lie on the left side, stiffening of 
the left shoulder, and various other symptoms attend this dis- 
ease. Delirium sometimes follows, which is sometimes quiet, 
at others raving. Fever is a common attendant of these symp- 
toms, and the whole of them so often arise in rheumatism, 
that they have been thought to be generally dependant on that 
disease. When these s3 7 mptoms arise in cases of rheumatism, 
they should be considered as a transfer of that disease to the 
heart, and treated accordingly. 

It is manifest that a rheumatic inflammation of the heart, 
with all its characteristic tendency to derange the ligamentous 
tissues, cannot be void of danger; and the most potent reme- 
dies should without delay be used to arrest it. Bloodletting, 
by means of cups and leeches over the breast, should be our 
first remedy, and after this is done, let a large blister be ap- 
plied over the part. The internal remedy mostly relied on is 
calomel, which should be given in doses of five grains two or 
three times a day, till a salivation is brought on. If the pa- 
tient is restless, give Dover's powder, in doses of twenty grains 
once or twice in twenty-four hours. Let the most rigid absti- 
nence be observed, and hope for relief, when a free salivation 
is brought on. 






DISEASES OF THE VEINS. 315 



DISEASES OF THE VEINS. 

The veins do not appear to be subject to man}' diseas 
but the few which may be fai . . . 1 as diseases of 

these organs, are of great importance. I shall restrict my 
to the notice of two of them, inflammation, and varicose veins. 

Inflammation of tke not a very frequent occurrence : 

it may arise spontaneously, or from wounds, or injuries. In 
_ cal operations, though not a very frequent consequence, it 
is looked on with the greatest dread. The peculiarity of this 
inflammation, is its tendency to spread along the trunk of the 
:1s towards the heart ; and "when suppuration takes place, 
to allow the matter to be thrown into the circulation of the 
blood. This is always a dangerous, frequently a fatal result. 
This inflammation may arise from trivial, as well as large 
operations; I have seen it arise from bleeding in the arm, and 
reduce the patient to sreat extremity, when there could be noth- 

-eenin the health of the patient, or nature of the opera 
to have led to the slightest suspicion of such a result. F 
larger operations, in which the trunks of veins are divided, in- 
flammation is frequently brought on, and in these cases, which 
too frequently terminate fatally, it will often be found, that 
5 have been formed in distant parts of the body, es- 
pecially the liver. The most common cause of dangerous : - 
>f inflammation of t: >arturition or delivery in 

childbed ; but of this we shall treat in another pla 

Inflammation of the veins, produces svmptoms so peculiar, 
that it may be easily discriminated from other inflammatory 
disorders. But little redness is seen in the affected part, and 
commonly the tumefaction, or swelling, extends to the whole 
limb in which the disease lakes place. There is great pain 

shivering, and commonly in this agony, a copious pe. 
ration is constantly present ; but the fever which attends it, is 
commonly typhus, with low pulse, great prostration, loaded 
and brown tongue, with other typhoid symptoms. When sup- 
puration has taken place, and the matter is thrown into the 
3m, a dangerous hectic fever takes place. 

TREATMENT. 

The treatment of this inflammation is by no means settled. 

n the highest authority, we are taught to practice local 

bleeding by leeches, cold applications, moderate cathartics, 



316 DISEASES OF THE VEINS 

and other remedies of a debilitating and exhausting charao 
ter. It is with great hesitation, that, from a limited experi- 
ence, I feel bound to enter my protest against this practice. 
It has not succeeded, in my hands ; and an opposite course, 
which has been tried by others, has proved abundantly more 
successful with me. The 2;reat remedies for inflammation of 
the veins, are opium and hot applications. There can be no 
doubt of the benefit of a brisk cathartic, given at the onset of 
these cases ; but unless it is practiced at first, it had better be 
omitted ; for these remedies will not operate under the use of 
the opium, which is so indispensable in the treatment of this 
disease. I do not know any particular rule in the administra- 
tion of opium. I have been in the habit of administering it, 
twice in twenty- four hours ; in extreme cases, a tea spoonful 
of laudanum, evening and morning. At the same time, hot ap- 
plications should be made over the course of the vesssels af- 
fected. A large poultice thrown into a bag, will retain the 
heat for several hours, and may be replaced by another when 
it becomes cool. The relief of pain which attends this prac- 
tice, is very great ; 1 have had my patients, for days together, 
demand the renewal of the heat, with great pertinacity ; while, 
in the same case, a temporary application of cold would be at- 
tended with the greatest aggravation of the pain. This course 
of treatment is to be kept up, as long as the pain and inflam- 
mation are present. The sensations of the patient will, many 
times, direct us very well ; they will call with sufficient punc- 
tuality for their dose of laudanum, and warm applications. 

Now, this seems to be a strange mode of treating an acute 
inflammation, in which the great danger is a suppuration of 
the parts concerned ; and I confess that I have been driven to 
the adoption of it, almost from necessity. There can be no 
doubt, of the great comfort and relief of pain afforded by this 
mode of treatment ; and when it is considered, that by these 
means, patients are deluged with perspiration, from day to 
day, it may be perceived that there is secured, by this treat- 
ment, a copious evacuation of fluids, which may hinder sup- 
puration. Whether this be a satisfactory explanation or not, 
is of little consequence ; if the practice recommended in the 
disease is successful, and greatly abridges pain and suffering, 
it is enough. 

VAUICOSE VEINS. 

These are exceedingly common, being found on the lower 
extremities of a great many persons. When slight, they 



DISEASES OF THE VEIXS. 317 

are productive of little inconvenience; and are commonly seen 
on the outside of the leg, in small crooked veins, sometimes 
enlarged into knots. When the disease is worse, the larger 
veins on the inside of the limb, are affected ; and then the dis- 
ease frequently becomes troublesome. The first inconveni- 
ence noticed, is a sense of weight, and bursting pain, when 
the patient stands on his feet. This pain is relieved by a hori- 
zontal posture of the limb ; and the patient is frequently seen 
to take a seat, and to raise the feet on another chair. The 
case may, at last, become too painful and inconvenient to be 
willingly borne ; and then it becomes a subject of medical 
treatment. There is no assigning any reasonable limit, to the 
enlargement of the veins in this disease. They sometimes pro- 
duce enormous tumours; and, in other instances, burst, and form 
exceedingly untractable and deep ulcers. The disease, when 
once established, is not very often entirely gotten rid of. Even 
when the cause is removed, as in pregnant women by delivery, 
the veins which have been injured, seldom return to their ori- 
ginal dimensions. 

Children are frequently born with certain points of varicose 
veins. They are first noticed producing a small bluish tumour, 
and are apt to spread and increase during life. I have seen a 
man whose nose had, from this cause, enlarged to five or six 
times its original dimensions ; and another, in whom they oc- 
cupied one of his lower extremities, in which the veins only 
grew, but the muscles and bones had scarcely attained half 
their proper size. The whole limb, when he was grown, ap- 
peared like a strange, vascular, membraneous sack. In all 
these cases, the size of organs thus distorted can be diminished 
by pressure. 

TREATMENT. 

Nothing would appear so simple as the removal of superfi- 
cial varicose veins ; yet few diseases have proved more untrac- 
table and difficult. For a long time, surgeons were in the habit 
of cutting across, and taking out portions of these veins; but 
these operations have been proved by experience, to be attend- 
ed with more danger than benefit. Small arteries which sup- 
ply the blood to these parts, have been taken up, with the ex- 
pectation that by cutting off a portion of the blood, these dis- 
eased veins would be enabled to circulate the rest. These 
operations are now considered generally useless. Pressure, 
when the part admits of its easy application, is perhaps the 
best remedy. Varicose veins of the lower extremities, admit 



318 INFLAMMATION OF THE STOMACH. 

of the application of a roller on the limb, in such a way as to 
mitigate the pain, and greatly relieve the patient. This is a 
remedy in the reach of every one. The patient should be 
taught to apply the bandage himself, in such a way as to ope- 
rate equally on all parts of the limb. Employments ought to 
be sought which favor the recovery from this disease of the 
veins. The patient ought not to be kept standing too much 
on his feet. 

Ulcers which are formed, by the bursting of varicose veins, 
are frequently attended with great and dangerous hemorrhage. 
The flow of blood has always, so far as I have seen, ceased, 
on the application of pressure, and placing the patient in a 
horizontal position. The healing of these ulcers is difficult ; 
but they require no particular remedy. Where the irritation 
becomes considerable, and the pain extends along the vein to- 
wards the heart, the patient should immediately be allowed to 
rest in a horizontal position, with a bandage moderately ap- 
plied on the limb. In this way, the inflammatory symptoms 
will be speedily removed, but the ulceration will not be gotten 
rid of in a reasonable time, unless the patient abandons all 
other pursuits, and keeps a horizontal position, till the cure is 
affected. 



INFLAMMATION OF THE STOMACH— GASTRITIS. 

This disease is to be divided into two forms — the acute and 
the chronic — the acute being so termed, because of its rapidi- 
ty, violence, and danger — and the chronic, because of its slow 
progress, and long continuance. 

Acute inflammation of the stomach, is a very rare disease, ex- 
cept from the action of corrosive poisons received into it. It 
is sometimes, however, met with as an original disease, not 
easily traced to any particular cause. Its symptoms are plain 
and striking. " Intolerable thirst, desire for cold and acidulated 
drinks, constant nausea and vomiting, pain and burning sensa- 
tion about the stomach, and fever — these are the symp- 
toms of a violent gastritis." If they are not arrested speedily, 
the patient rapidly sinks into a state of great prostration of 
strength, with feeble pulse, cold extremities, and profuse per- 
spiration ; and death, follows in a very short time. But this 
result is not always inevitable. The symptoms are sometimes 
less violent, and a greater time allowed for their futher de- 
velopment. Respiration is hurried — the pulse rapid, with 



INFLAMMATION OF THE STOMACH. 319 

great restlessness and inability to sleep — excessive tenderness 
and dread of pressure in the region of the stomach, point out 
t he disease with some degree of certainty. 

These symptoms, or several of them, occur in other diseases. 
I have seen almost every one of them in cholera morbus, and 
as many in bilious fever ; and there are other diseases furnish- 
ing the same appearances. To discriminate these from acute 
inflammation of the stomach, is not always easy. In most 
cases, a short time will disclose s} r mptoms of other diseases — 
in bilious fever the discharges from the stomach are more pro- 
fuse, the tenderness of the epigastrium less, and the suspicions 
arising from the season of the year, and the locality of the pa- 
tient, will protect us from error : — in cholera we have the same 
protection, and in attacks brought on by corrosive poisons, a 
close investigation will commonly enable us to judge correctly ; 
but the pride of science must give way to the stubborn fact, 
that our greatest protection from error in recognising this dis- 
ease; is found in the rarity of its occurrence. 

Equally obscure is the investigation of I he sympathetic rela- 
tions of the stomach, with other important organs. Examina- 
tions after death have proved, that the diseases of the stomach 
have produced symptoms of disease in other organs, when 
those organs were not at all diseased. They have rendered it 
also probable, that if these symptoms, at first sympathetic, are 
allowed to exist for a length of time, the organ thus affected 
becomes itself diseased. Thus inflammation of the stomach, 
is known to have produced symptoms of inflammation of the 
brain, or of the lungs, or of the intestines. I think 1 have seen 
this in cholera infantum, where the lungs took on symptoms of 
inflammation, or the brain of dropsy, and these symptoms gave 
way on the proper treatment of cholera, with great irritation of 
the stomach. Nor is it to be questioned, that these cases, if 
allowed to continue, mi^ht have resulted in inflammation of 
the lungs, or dropsy of the brain, as the case might be. The 
development of these relations of important organs is yet in 
its infancy ; and it must be confessed, that thus far in the ma- 
jority of the cases in which these strange relations of distant 
organs have been found to exist, they were not suspected be- 
fore death. 

TREATMENT OF ACUTE INFLAMMATION OF THE STOMACH. 

Recollect that acute gastritis is a very dangerous disease. 
All the remedies used in it should be thoroughly and faithfully 
tried. The patient must try to forget his thirst, pain or de- 



320 INFLAMMATION OF THE STOMACH. 

sires of any kind, and do that only which will favor his re- 
covery. He should not take a drop of water, far less a mouth- 
ful of food, unless it is exactly in conformity with the direcr 
tion of his physician. He should also submit to the prostra- 
tion of his strength, and not by vain and pernicious efforts to 
serve himself, lessen or destroy his hopes of surviving the 
attack. 

Emetics. By far the greatest number of cases of acute inflam- 
mation of the stomach, depend on offending matter taken into 
the stomach. This should unquestionably, be ejected in the 
most speedy manner. Emetics are the readiest means, and 
should be chosen from the mildest, most certain, and speediest 
articles in their operation. Ipecac, and sulphate of zinc, pos- 
sess these qualities in an eminent degree ; the dose of either ar- 
ticle is about the same — from ten to thirty grains, in water. 
The operation is far less painful than might be expected. I 
have found it far less than the apprehension of medical writers 
had led me to suppose it would be. These remedies, or either 
of them, are not always improper when the disease has arisen 
spontaneously. If the case is seen promptly, they are given 
without danger ; and I have seen the appearance of bile in the 
discharges thus brought on, seem to give the greatest relief. 
But in most cases, the patient is not prescribed for, till by the 
vomiting attending the disease, every thing whjch can, in this 
way, be discharged from the stomach, is thrown up. The 
draughts of water so useful at this stage, in diluting the con- 
tents of the stomach, cooling its burning heat, and limiting its 
contractions by affording a matter easily discharged, have been 
taken. There is no longer any use for emetics — their use will 
be improper under these circumstances. They are not called 
for when corrosive articles, such as antimony or copper, which 
are emetics of themselves, have caused the disease. But wa- 
ter, tepid or cold, is to be used in all cases, on the commence- 
ment of the attack. 

Leeches and bloodletting. These are the great remedies for in- 
flammation of the stomach. There is but a moment, in which 
to use general bloodletting. The discharges from the stomach, 
are so great, and the prostration so sudden, that this powerful 
remedy cannot be used, except it is in the commencement of 
the disease. It is doubtful whether it is ever requisite, in ca- 
ses arising from corrosive poisons. But in other cases, there 
can be no doubt of the great benefit of the abstraction of blood 
from the arm. Leeches are more generally useful. They 
should be applied at the pit of the stomach, or at the point of 



INFLAMMATION OF THE STOMACH. 321 

the greatest tenderness. They are considered by far the best 
remedy for this complaint, and are to be used, at first in con- 
siderable numbers, and according to circumstances throughout 
the treatment. They are to be repeated from day to day, so 
long as the fever and tenderness of the stomach continue — due 
regard being paid to the strength of the patient. 

Ice and water. This grateful article, is to be used cautiously, 
in a small quantity at a time, but is to be considered not only 
a necessary amount of drink, but a remedy. The ice may be 
swallowed whole, or dissolved. I do not think its remedial 
piopertiesat all improved, by the addition of lime juice, or su- 
gar, or any thing else. If ice cannot be obtained, let cold wa- 
ter, in minute quantities, be substituted. Nothing can be more 
hurtful than the unlimited indulgence of thirst, in swallowing 
large draughts of water, and throwing them up as soon as they 
are swallowed ; but in my practice, nothing has been so bene- 
ficial as water administered in such quantity, as the stomach 
would retain without inconvenience. 

Blistering. This is an important remedy in almost all cases 
of local inflammation. It had, for a long time, far too much 
credit as a remedy for diseases — its true place is, I fear, not 
yet found ; and I think too little regard is beginning to be paid 
to it. Cold applications, by napkins dipped in the coldest wa- 
ter, or, ice applied in bladders over the stomach, have almost 
driven blisters from the treatment of gastritis. But they have 
their time. Let the cold applications have their place during 
the first stage of the disease ; but if the irritation continues af- 
ter the fever has, in some degree, subsided, and the skin be- 
comes bedewed with perspiration— apply a large blister 
over the stomach. I have no hesitation in saying, that at that 
stage of the complaint, blistering is more serviceable than 
leeches, or any other remedy with which I am acquainted. 

Opium. This remedy is, of limited use in inflammation of 
the stomach. The great control it exerts over irritation, drives 
us to the use of it to control excessive vomiting in the outset. 
Its effect in cases of true inflammation of the stomach, I should 
think would be temporary. The dose should be large, and not 
often repeated. Its control over the action of emetics is various. 
Over tartar emetic it exerts a powerful control ; over ipecac, 
or over verdigris, I have found it nearly powerless. But in 
cases of great prostration, I should not hesitate to give lauda- 
num by way of injection. Nor should I fail in the last ex- 
tremity, to remember that there was a comfort in this remedy 

21 



322 INFLAMMATION OF THE STOMACH. 

to be found in no other ; and that however desperate appear- 
ances might be, a recover}? was yet possible. 

Cathartics. No one would think of giving cathartics as a reme- 
dy for inflammation of the stomach ; yet as there is a harm in 
the cosiiveness which frequently attends it, the question, " what 
shall be done to move the bowels ?" forces itself on us. Injec- 
tions naturally suggest themselves, and should be preferred 
to more active means, as a general rule — they may be made 
active by additions of the neutral salts, or perhaps spirit of tur- 
pentine, but they will not always answer. I should still be 
very deliberate in deciding to use a cathartic. I should allow 
several days to pass ; but when the stomach seemed to be re- 
stored to its tranquility, I should prescribe a dose of castor oil, 
a Seidlitz powder, or some equally mild cathartic. If the case 
had been one of extreme prostration, great care should be ta- 
ken, not to allow the patient to use any unnecessary exertion, 
or to rise to an erect position to have his evacuations ; and 
laudanum should not be forgotten, if the operation seemed ex- 
cessive, or the patient faint. 

Food. During the first stage of this disease, it would be as 
unreasonable to offer food to the patient, as to order him to 
march thirty miles — his stomach would be as incapable of the 
one service, as his muscles of the other. But the time must 
come, if he recovers, when food, to replenish the waste of bis 
body, must be taken. It should be the least stimulating ; and 
perhaps not over nutritious. We may not find the digestive 
powers very much weakened, for this case is no dispepsia. 
The patient may, therefore, be allowed a little greater range of 
articles from which to choose. Ripe fruits, especially stewed 
or baked, without much sugar, will be allowable, probably as 
soon as any thing. Bread stuffs follow ; and 1 think but little 
benefit will be done by reducing them to a fluid, or semi-fluid 
state — next animal soups, and flesh taken cautiously. 

CHRONIC INFLAMMATION OF THE STOMACH. 

The distinction between chronic inflammation of the stom- 
ach, and dyspepsia, is so far from being clear, that the ablest 
practitioners have either regarded them as identical, or so con- 
founded their account of them, as to destroy the line of demar- 
cation altogether. I have chosen to treat separately of these 
affections ; for admitting, that dyspepsia will produce, and co- 
exist with, chronic inflammation of the stomach, it often exists 
without that connexion ; and although a stomach inflamed can 



INFLAMMATION OF THE STOMACH. 323 

no more perform its function perfectly, than an eye inflamed 
can bear without pain, the light of the sun ; inflammation of 
the stomach may exist independent of dyspepsia. In these 
cases the treatment is to be entirely directed to the removal of 
the inflammation : and I shall confine my remarks to such ca- 
ses as have arisen independently of dyspepsia. The subject is 
of acknowledged obscurity, and I shall not pretend to have ren- 
dered it less so. 

causes. 

The stomach, we have seen, is rarely attacked, with a pri- 
mal-acute inflammation ; it is, in my opinion, as rarely attacked 
with a primary chronic inflammatijn. The cases I have met 
with, have been mostly in persons addicted to stiong drink ; 
and I think the cases of inflammation of the stomach from this 
cause, are apt to be without dyspepsia. 1 know it is common 
to assign to this cause, the production of indigestion ; and I 
have seen many a cadaverous, thin, and wasted drinker, ter- 
minate his short career as a victim of dyspepsia ; but the ma- 
jority of drunkards give evidence of increased digestive pow- 
ers ; living and thriving through great excess in eating as well 
as drinking. It is in such as these, that I have seen cases 
of chronic inflammation of the stomach. Other causes certain- 
ly produce this disease. There can be no reason wdry the 
stomach should not be sometimes the original seat of its own 
diseases. Inflammation attended with ulceration or otherwise, 
unquestionably takes place in the stomach, from defects of its 
own. It may also happen from exposure to cold, or too long 
protracted dampness, or other general causes of inflammation. 
Certain articles of food, or medicines too long persisted in, may 
result in the same state. 

SYMPTOMS. 

The attacks of this disease are insidious. The languor, 
mental lethargy, cold extremities, and flatulence which attend 
dyspepsia, are perhaps more conspicuous in this, than in other 
forms of that disease. Pain about the pit of the stomach, with 
tenderness on pressure, may be expected to be present. But 
the pain which arises from the presence of food in the stom- 
ach, and from the common stimulant and tonic remedies, 
which are almost always offered to such patients, give per- 
haps the best evidence of the nature of the disease. These 
effects of remedies are perhaps the first to produce a fear in 
the mind of the practitioner, that his patient has inflammation, 



324 



INFLAMMATION OF THE STOMACH. 



ulceration, or possibly cancer of the stomach. The exact state 
of the viscus remains a secret till death, and an examination of 
the body discloses all. It was the fate of Napoleon, to sink 
under an unknown disorder of this kind, which was only made 
manifest by the dissector's knife. 



TREATMENT. 



The usual remedies for chronic inflammation, are to be em- 
ployed here, with due regard to the functions and position of 
the stomach. Small bleedings, or leeches over the stomach, 
repeated according to circumstances. Blisters, or tartar emet- 
ic ointment, rubbed on till a pustular eruption is brought on — 
cold applications over the stomach, and the prudent use of ice 
or cold drinks. These remedies naturally suggest themselves 
to the mind; but the disease being in the stomach, the common 
receptacle of medicine, food, and drinks, makes it necessary to 
pay particular attention to these. 

Medicines. There are few articles bearing the name of medi- 
cine, that I would willingly pass into an inflamed stomach. To 
lessen irritation and pain, give opium — from a fourth to half 
a grain of acetate of morphine, or its equivalent in laudanum. 
These may be repeated, according to the necessity of the case. 
Nitre — salt petre — in doses of from five to ten grains, given 
some hours after meals. If the bowels are costive, use injec- 
tions ; and if these fail, consider yourself compelled to give 
castor oil, rhubarb, senna, or some other mild cathartic. Let 
these remedies be used as seldom as possible — not oftener 
than twice a week. This I know will be thought too seldom, 
by many who have been taught to think " a soluble state of 
the bowels," the first requisite in the treatment of every dis- 
ease. But I say without hesitation, disturb the bowels as sel- 
dom as possible in chronic gastritis. This rule is the more 
necessary when the patient is sinking under ulceration, or 
perhaps cancer of the stomach. It would be easy to mention 
many remedies which have been recommended in these cases. 
But to what purpose ? The curable cases will yield to these, 
the incurable to nothing in our reach. The field is wide, and 
open for discovery ; but, alas ! it is but slowly cultivated. 

Food. This should be taken cold. Care should be taken to 
choose articles which are least stimulating, rather than those 
which might be thought more easily digested. The farina- 
ceous kinds, without milk and cream, or fresh butter, afford, 
as I think, the best. Rice, stale wheat bread, or mush, or 



DYSPEPSIA. 325 

small hominy, are the articles, I would prefer. Let it be 
recollected, that in these cases there is no possibility of avoid- 
ing the use of food. The disease is too chronic. Every phy- 
sician will agree, that the water and gum regimen, of Brous- 
sais, has been carried too far, in many cases. We must not 
forget, that our patients must live ; and that the replenishment 
of the waste of nature, is one of the conditions of life. But to 
obtain nutrition through the action of an inflamed stomach, is 
often a difficult, a painful, or an impracticable matter. I ad- 
vise, in these cases, the use of food as seldom as possible. 
Yet twice a day would seem to answer better than less fre- 
quently. But this rule must be varied to suit the experience 
of the patient. I have had one under my direction who pas- 
sed the day in comfort, except from a tormenting hunger, by 
taking only one meal, a tolerable fair one, in each twent} r -four 
hours. This meal was taken near twelve o'clock, M. Eve- 
ry attempt to take supper or breakfast, was punished with 
great excitement, fever, and prostration, for at least one day. 



DYSPEPSIA— INDIGESTION. 

What system shall I adopt — what books shall I study — 
what shall I sa} T , or what forbear on this eternal theme ? 
There can be no doubt that in civilized nations, it is by far 
the most common of all diseases. The variety of its s} T mp- 
toms, its wide spread sympathies, and concomitant disorders, 
have distracted the nosoWist, misled the theorist, and hum- 
bled the ablest of its investigators. But we have arrived at 
the age of " matter of fact.'''' Dyspepsia is beginning to be in- 
vestigated. Some important facts with regard to it, are 
known — the remedies for it, are more reasonable, and I have 
no doubt far more successful, than those formerly used. 

CAUSES. 

It will not be thought strange, that this is the most common 
of diseases, when it is considered, that whatever is used for 
the support of the body, is first thrown into the stomach. That 
whether it be food or drink, with the exception of water, it is 
to be prepared, or digested in the stomach, before it can be 
admitted into the system. That this viscus must bear the ex- 
cesses of gluttony and intemperance — the hardships of pover- 



3*26 DYSPEPSIA. 

ty, and the ignorance of cooks, and, shall I say of physicians f 
Nor will the universality of this complaint, be thought the less 
reasonable, when we consider the variety of articles thrown in- 
to the stomach as food. The stomachs of other animals have 
their appropriate food — the lower tribes being confined to a 
single article ; but widening in its range as it rises to man, he 
eats everv tiling ; he is called omnivorous. But not content 
with the high privilege of eating all kinds of food, he mixes 
many articles into the most discordant dishes ; and these he 
eats with an excess provoked by every artificial stimulant, he 
has had power to obtain or invent. Is it strange that his stom- 
ach is diseased by this outrageous treatment ? 

Excess in eating and drinking, 1 have no doubt, is the most 
common cause of indigestion. The stomach is taxed beyund 
its powers. With a peculiar appetency — shall I say instinct, 
it refuses to digest more than is needed, and is disordered by 
the excess. This excess applies as well to water as to food. 
I think I have seen excessive draughts of water, produce the 
worst consequences, when taken on excessive meals. The 
evil is greatly aggravated by the habit, now too common, of 
eating very little except at a single meal. The stomach should 
not be required to digest food for a whole day at one time. It 
is unreasonable, and I have witnessed the ill effects of it. Star- 
vation, by a well known law of animated beings, produces the 
same state of things with excess in eating. Excess destroys 
the power of digestion by overtaxing it ; starving destroys it, 
by giving it nothing to do. What power can we preserve 
without exercising it? 

Unwholesome food is a common cause of indigestion. Pu- 
trid meat, or unsound bread, or vegetables, will soon shew 
indigestible qualities ; and if the use of them is persisted in, 
disorder the stomach. There are many articles of food natu- 
rally very hard of digestion, and taken at our peril. Cheese, 
dried or smoked fish, and many succulent vegetables in com- 
mon use, may be mentioned as examples. Tea and coffee 
have not escaped this censure ; and pastry of all kinds, has 
been placed under the ban. But I confess I have thought 
most of these articles were more blameable for causing exces- 
sive eating, than for their own ill qualities. 

Xo organ of the body has wider connexions, or closer sym- 
pathies with other organs, than the stomach. With the skin, 
it harmonizes in a wonderful manner. Some of its diseases 
seem to be thrown off on the skin ; and a checked perspira- 
tion often produces an attack of dyspepsia. With the bowels 



DYSPEPSIA. 327 

its connexion is evident — indigestion is often produced by cos- 
liveness. The liver also has stood for the greatest responsi- 
bility to dyspeptic patients. It is losing some of its pre-emi- 
nence in this regard, since the days of Abernethy. But I think 
the regard to it, is becoming too little. The stomach can hard- 
ly perform its office if it is not duly supported by the liver. I 
might go on with these sympathising organs, but 1 will not. 
The discussion seems to me unprofitable. We can seldom tell 
the primary affection in these cases. We charge a disorder of 
the kindneys to dyspepsia : do we know which organ, the 
stomach or kidneys, has caused the disease? 

The power of the mind over the stomach, is a fact long ago 
noticed. A brooding melancholy belongs to indigestion ; but 
it is not alwa}'s easy to determine whether they are mutual 
disorders, or one dependant on the other — whether the brain 
or the stomach, or both, are in fault. That the disease under 
consideration, mav arise from affections of the mind, is render- 
ed probable from the often observed fact, that the appetite is 
in a moment destroyed by hearing bad news, or by any in- 
tense mental excitement. 

The habitual use of cathartic medicines, is, I have no doubt, 
a fruitful source of dyspepsia. I have myself seen many ca- 
ses that, after investigation, I felt authorised to charge to this 
cause. 

fndependent of all these causes, there are unquestionably 
many persons who, from constitutional predisposition, become 
dyspeptic. There are very few persons who have not, at some 
time, experienced some of the inconveniences of indigestion. 
The child a day old, whose only food is its mother's milk, is 
frequently affected with a violent d\ T spepsia in the form of 
colic. I have seen these cases attended with cold extremities, 
paleness and flatulence, in the same manner with grown per- 
sons. These symptoms could hardly depend on the unwhole- 
some quality of the mother's milk, to which they are common- 
ly charged. In other cases, the child rejects its mother's milk 
from the first, and has fever and all the symptoms of inflamed 
stomach. These children, when they arrive at a maturer age, 
are still dyspeptic. They are born with defective digestive 
powers, and must live in pain and suffering, or regulate with 
great exactness, their diet and drink. Several cases now oc- 
cur to my mind, confirming these views. Dyspepsia is, then, 
sometimes an inherent disease. The physician has in these 
cases, a field for his skill. He may offer remedies, and sug- 
gest regimen, that will greatly alleviates the sufferings ; but he 



328 DYSPEPSIA. 

is not to expect his patient to rise to a vigor of digestive pow- 
er, not granted him by nature. When food is received into the 
healthy stomach, a fluid exhales by drops from its internal sur- 
face, in sufficient quantity for its digestion. This fluid is the 
gastric juice, whose properties are, with all that chemistry has 
accomplished, but illy understood. It is said to be, in every 
instance, acid, and this acid principally the muriatic ; but eve- 
ry attempt to procure from other sources than the secretion of 
the stomach, a fluid with the properties of the gastric juice, 
has signally failed. This fluid, whether within? or out of the 
stomach, has the property of reducing food to a semi-fluid 
state ; and this is the act of digestion. In this state, the food 
is called chyme ; and is passed out of the stomach into the 
duodenum, or first small intestine, to undergo other, and equal- 
ly important changes. The gastric juice does not collect 
gradually in the stomach, producing by its presence the sen- 
sation of hunger, as was once thought. Its collection around 
the food in the stomach, more resembles the flow of saliva 
into the mouth, when irritating substances, such as tobacco, 
are taken into it. The muscular contractions of the stomach, 
give to the food contained in it, the variety of exposure neces- 
sary to bring all its particles in contact with the gastric 
juice, that its digestion may be complete. It is not known 
whether indigestion arises from a defect in the quantity, or a 
fault in the quality of the gastric juice. But it is certain, that 
when solid food properly masticated, is introduced into the stom- 
ach, it is there reduced to chyle, of which it does not contain 
a particle in its state of original organization. When it is de- 
fectively masticated, and left with solid portions in it, the di- 
gestion is slower, but still is accomplished in the end. When 
a portion is digested, and there remains a portion in unmasti- 
cated pieces, these remain in the stomach till their digestion is 
effected. When a substance is totally indigestible, or from its 
quantity is incapable of being digested, it is passed in this state 
out of the stomach, into the intestine. These facts were dim- 
ly seen, and variously guessed at, till in the year 1833, when 
Doctor Beaumont published the experiments he had made on the 
subject of digestion. Fortune had placed under his care, a 
healthy man, who had recovered from a gunshot wound which 
had laid open the stomach, and left an opening which never 
closed. Into this opening, substances might be put, and with- 
drawn at pleasure ; through it the operations of the stomach 
could be seen, and investigated in a manner never before wit- 
nessed. The observations which were thus made, through a 



DYSPEPSIA. 329 

series of years, are a great gift to the medical profession ; and 
have put into our possession a remarkable collection of facts 
not otherwise obtainable. 

The changes wrought on fluid aliments, while in the stom- 
ach, are not so obvions. Water, ardent spirit, and some oth- 
ers, seem to pass through the stomach unchanged, and in a 
very short time. Soups, especially animal, are detained as 
long as solids. The time in which food is usually digested, is 
from two to six hours ; the longest time being sufficient for the 
digestion of the hardest tendinous portions of food. 

SYMPTOMS OF INDIGESTION. 

The lowest form of dyspepsia is made manifest by cardial- 
gia, or heartburn — a sensation of burning pain at the pit of the 
stomach, with eructations of acid into the throat or mouth, pro- 
ducing an acid taste and scalding sensation for several hours, 
or till the food in the stomach, which has given rise to it, has 
passed into the bowels. There are few persons who are bles- 
sed with a stomach so powerful, as not to have been, at some 
time, thrown into this degree of indigestion. Flatulence, de- 
bility, and sluggishness are its common attendants. These 
symptoms commonly occur after eating indigestible food, or an 
inordinate meal of food to which no valid objection can be 
made. They are renewed, from time to time, according to 
the progress of the disease. 

But this low degree of dyspepsia, does not always manifest 
itself by the same symptoms. The stomach is sometimes op- 
pressed with acid, which produces no heartburn, but in other 
respects the same symptoms, except the eructations. I have 
met with many, who aver that they are not sensible of acid on 
the stomach, and }^et, on throwing up its contents, find them 
intolerably acid. 

On a little investigation, it will commonly be found, that 
these symptoms have been preceded by others tolerably well 
marked. These are cold extremities, paleness, debility, slug- 
gishness, flatulence, and costiveness. These, with a despond- 
ing mind, and irritable, and impatient temper, might stand for 
hypochondriasis, and do many times exist independent of dys- 
pepsia. But they oftener so run into and combine with that 
disease, that they cannot be considered separately. 

In other cases, the stomach, instead of digesting its food, re- 
jects, or throws it off, by eructations or vomiting. Frequently 
the food, taken half an hour before with keen appetite, is belch- 



330 DYSPEPSIA. 

ed up, mouthful by mouthful, unchanged in its taste, or only 
altered by becoming a little sweeter than it was when swal- 
lowed. The next meal perhaps of the same patient, will be 
ejected in the same way, but so acid as to scald the throat, 
and produce all the symptoms of a violent heartburn. All this 
occurs with very little nausea ; and when from an aggravation 
of the disease, full vomiting takes place, the patient will still 
tell you he has no sickness at the stomach. 

In the same class of moderate dyspepsia, I place pyrosis, a 
disorder which from its striking symptom — a discharge of large 
quantities of transparent glairy fluid from the stomach, has at- 
tracted a great deal of attention. This form of dyspepsia very 
often presents itself in high latitudes, especially amongst the 
poor who are badly clothed and worse fed. It is so rare in 
this region that I recollect to have met with it only twice, and 
neither case proved, in the least degree obstinate or untracta- 
ble. 

Such are the Protean shapes in which this disorder presents 
itself, even in its first stage, I have no thought that I have de- 
scribed the half of its symptoms ; but in the complicated forms 
in which it appears, at a later stage, the attempt to follow it 
may well be considered vain. It is our duty however to pro- 
ceed. 

Before the patient is aware of it, great tenderness of the epi- 
gastrium has taken place. Doctor Philip, I think, first noticed 
its occurring nearly over the lower orifice of the stomach, ex- 
tending along the margin of the false ribs. I have examined 
it in cases in which, although the tenderness was great, it did 
not extend over a surface larger than half a dollar. Soon, how- 
ever, it becomes more extended, and there occurs a considera- 
ble enlargement along the margin of the false ribs, on the right 
side. 

About the same time, aphthous ulcers appear about the 
mouth, commonly on the inside of the lips opposite the teeth, 
producing considerable irritation and pain. The same kind of 
ulceration, we are assured by Doctor Beaumont's observations, 
presents itself, at the same time, on the mucous surface of the 
stomach. 

Pain in the stomach is the next symptom we shall notice. 
This presents itself under more forms, and different aspects, 
than any other symptom. It is sometimes constant, but not 
violent, producing nearly all the time a sense of weight and 
fullness of the stomach. Food, sometimes of the most indi- 
gestible kind, is sought and taken, and for a time seems to af- 



DYSPEPSIA. 331 

ford relief. In other cases the stomach is violently pained, 
after eating, and not relieved till the offending substance is 
thrown up. Sometimes the matters ejected are very acrid. 
The pain in other cases, not less violent, seems not to produce 
cramp or vomiting, but extends through adjoining viscera, es- 
pecially the liver. In other instances, the head seems to par- 
ticipate in the disorders of the stomach, in a wonderful degree. 
I have often given a few grains of ipecac to cause an evacua- 
tion of the stomach, and found instant relief of headache, from 
its operation. 

The pain which exists, from inflammation, ulceration, or 
cancer of the stomach, will, almost in every instance, be at- 
tended with dyspepsia ; but may obviously exist independent 
of that state of the stomach. The pain in these cases points 
out with some accuracy, the seat of the complaint; but it avails 
us very little to know this. The inflammation is not known to 
exist in any great variety of form or appearance, and the reme- 
dies hardly vary, in different cases. Even cancer, if it exists, 
calls for nothing different from the ulcerations, thought to dif- 
fer altogether in kind. 

In whatever form it may appear, dyspepsia is apt to be a 
disease of paroxysms, and intervals. These commonly de- 
pend on the action of the food, or rather of the stomach on the 
food taken into it. But there are cases in which the absence of 
food produces the paroxysm, and others in which it seems in- 
dependent of the presence or absence of food in the stomach. 

In any of the forms under which it has been described, dys- 
pepsia may become an intolerable disease. Deprived of nutri- 
tion, the powers of the body fail; other organs become diseased, 
and the patient sinks, under accumulated affliction. But post 
mortem examinations have proved, that the ulceration or inflam- 
mation of the stomach,- indicated, by the symptoms, are not al- 
ways present. Death has been brought on by this disease, 
when the examination made for the cause proved entirely fruit- 
less. The stomach and intestinal canal appeared entirely 
sound, disproving the theory of Broussais, that this disease was 
but a chronic inflammation of the stomach. 

The various disorders, arising from dyspepsia, in distant 
organs, will not be considered here. It would fill a volume to 
treat of them ; and when it is attempted, every inch of ground 
is disputed. Authors have not scrupled, to charge to the im- 
perfect performance of its office by the stomach, many disea- 
ses of the liver, spleen, kidneys, intestines and even the brain. 
It matters not whether they are always right, or not. Organic 



332 DYSPEPSIA. 

diseases of these parts, require a treatment of their own, wheth- 
er they may have arisen from dyspepsia or not. If dyspepsia 
be present, or if, according to Doctor Philip, it has given way 
to a disease it produced, the course of treatment is the same. 
The remedy must be, for the relief of the present malady ; and 
if its relief shall be followed by a return of* the dyspepsia, this, 
in its turn, is to be properly treated. 

TREATMENT OF DYSPEPSIA. 

The mildest form of dyspepsia, in which a slight oppression 
at the stomach, with flatulence only is felt, is seldom the ob- 
ject of medical treatment. In healthy persons, it requires only 
the removal of the cause, over eating. It is hardly going too 
far. to say, that few persons are entirely guiltless on this head. 
Very few who have from this cause, felt no greater evil than a 
little flatulence and oppression at the stomach, will heed the 
counsel of the physician, and eat with more moderation. But 
the victims of temerity on this head, are too many, to be 
thought of with indifference. It is in this mild stage, that a 
little prudence is most important. To the strong and power- 
ful, who live in total disregard of all our admonitions in regard 
to temperance in eating, let the maxim of an Italian writer, 
who, at the age of ninety years, wrote a book on temperance, 
be often repeated, " if you would live to eat a great deal, eat but 
little at one time." This maxim, important to all men, is vital 
to those who, from original weakness or acquired predisposi- 
tion to dyspepsia, are reminded of their frailty, by flatulence 
after every meal. Such a person should, if he has not done so, 
adopt a regimen suited to a dyspeptic. He should carefully 
note the effect of over eating, and the articles of food he may 
have taken, and, with firm resolution, cleave to that which he 
finds best. His habits should also conform to his disorder — 
his exercise should be in the open air, and his food spare in 
comparison with his exercise. 

But we pass on to a more serious form of dyspepsia. In 
this, I am considering the patient as laboring under paroxysms 
of painful heartburn, with its concomitant symptoms. The 
disease has continued for some time ; but with very little ten- 
derness over the stomach, and no fever. The mouth, in the 
morning, will probably be dry, and the tongue coated with a 
white, or even a yellowish fur or mucus. In such a case — 

Costiveness is to be removed by the following pill : Take 
of aloes, 60 grains- — Gamboge, 10 grains ; rub together, 






DYSPEPSIA. 333 

and add syrup or water — make it into 16 pills. Let two be 
taken at bed time ; and, if no movement of the bowels is 
brought on by the next morning, take one more. Conunue 
them, from day to day, to produce at most, a daily evacuation 
by the bowels. If one pill a day, or one in two or three days, 
shall prove sufficient, it will be so much the better. If, from 
tenderness of the rectum, or a general irritability of the system, 
these pills produce burning stools or fever, desist from the use 
of them. If the costiveness returns, give the following : 
Take of powdered rhubarb, 60 grains — powdered ipecac, 
20 grains ; mix with water, and divide into 24 pills. These 
pills are to be taken, one by one, to produce the desired effect, 
a daily evacuation. If they produce vomiting, compound an- 
other parcel, with only ten grains of ipecac. These pills may 
be used for any length of time, so far as my experience goes. 

For the same purpose — the removal of costiveness — injec- 
tions have been sometimes found sufficient. The mildest 
should be first tried ; but if these prove ineffectual, soap-suds, 
solution of salt, or other acrid articles may be tried. If the 
milder kinds prove effectual, they are to be preferred to all 
other remedies. 

The presence of superabundant acid in the stomach, mani- 
fested by the burning pain and acid eructations, calls for the 
use of such alkalies and absorbent remedies, as experience has 
warranted us in using. Not the least useful of these, is a weak 
ley made by throwing a little ashes into a tumbler of water. 
If the ashes are taken hot from the fire, the ley becomes trans- 
parent in a few minutes, and may be drunk, a mouthful every 
four or five minutes, till relief is obtained. Doctor Physic, I 
recollect in one of his lectures, recommended this preparation 
of ashes, to be stirred and drunk in an unsettled state. 

Prepared chalk is perhaps the least exceptionable remedy of 
this kind. A piece as large as an almond is commonly enough, 
and may be repeated according to circumstances. 

Magnesia, especially when calcined, combines readily with 
the acid in the stomach, forming a neutral salt which is mildly 
cathartic. It should not be too frequently resorted to — its ac- 
tion on the bowels, being qualified to lessen their secretions 
and produce costiveness in the end. 

Having by these means, provided for a regular, if not a 
healthy action of the bowels, we are next to look to the reme- 
dies calculated to give tone or strength to the digestive pow- 
ers. Doctor Philip, whose very able work was one of the first 
lights that broke through the gloom of this subject, recom- 



334 DYSPEPSIA. 

mends, if I remember correctly, a tea spoonful of brandy 
or other good spirit, to be taken with a little water at meals, 
especially dinner. This small quantity, which is by no means 
to be much increased, affords the most powerful aid to the di- 
gestive powers of the stomach. There is some responsibility 
in recommending this medicine, regarded so dangerous to the 
cause of temperance ; but what is better — what is equal to it ? 

When the above was written, I had not for many years look- 
ed into Doctor Philip's essay. I find that my memory was 
not perfect in regard to his maxim. The advice as I have of- 
fered it, is the result of my own experience, and I have no 
doubt of its correctness. Nor does it differ so widely from his, 
as to render the matter of much consequence, except for the 
unpopularity of alcohol in these days of temperance lectures. 
That able physician, whose work on indigestion ought to be 
reprinted and extensively circulated, came to the conclusion, 
that distilled spirit, taken in small quantity with water alone, 
promotes digestion more than any thing else ; and especially 
more than wine, or any other fermented liquor. So important 
is this consideration, that he advised its use in certain cases, 
although in its ultimate effects, he regards it as the worst of all 
stimulants. That he, with his opinion of its ultimate effect, 
consented to use it at all, is evidence of the great difficulty of 
finding a substitute for it. I confess that I have found nothing 
else equal to it. Nor do I think Doctor Philip is sustained by 
facts, in his preference of fermented over distilled liquors. 
The abuses of distilled liquors may be most destructive, be- 
cause of their greater concentration ; but the Washingtonians 
are right in refusing either as a " beverage." 

Tonic medicines, of which I think gentian the best, are also 
to be given here. The extract of gentian is a very simple, and 
valuable prescription. Make it into pills with powdered gin- 
ger, each pill of the common size — about four grains. From 
three to six a day, may be given for weeks, if necessary. The 
compound tincture of gentian is also a good remed} r . Give a 
tea spoonful — one sixth of an ounce — in water before breakfast, 
and before dinner. The dose should not be much increased. 

Mineral tonics are to be resorted to, if the patient is pale, 
and much affected with cold extremities. The preparations of 
iron are best. The precipitated carbonate may be made into 
pills — put sixty grains into sixteen pills — and give four to 
six a day. The sulphate of iron, common copperas, is often a 
better remedy, but is an inconvenient preparation. By drying 
it over the fire, in an iron vessel, till it becomes a white pow- 



DYSPEPSIA. 335 

der, it may, b\ T the aid of turpentine, 'be made into pills. They 
should be of the common size, and given one or two at a time, 
twice a day. 

I think it unnecessary to extend this list of remedies. Let it 
be borne in mind, that they are applicable to cases unattended 
with fever, or organic disease. Many times they will be found 
inapplicable to the case — the gentian will "rise on the stom- 
ach," or be tasted in eructations — the brandy will produce 
flashing, perhaps palpitation at the heart — the aloes will in- 
flame the bowels — the ipecac will prove emetic, in spite of re- 
ducing its quantity. Cease to give remedies producing such 
manifest inconvenience. Most of these evils arise from ad- 
ministering these remedies when there is a lurking inflam- 
mation, or hidden ulceration present. No one can always fore- 
see these evils, and there is consolation in knowing, that the 
harm of the experiment can hardly be much, while the infor- 
mation afforded by the result, may be very important. 

Food and drink. I have said that dyspepsia is more frequent- 
ly produced by improper food, excess in eating, and improper 
or excessive drink, than by any thing else ; and must there- 
fore, in all consistency, insist on the strictest regulated diet for 
its removal. The variety of this disease of which I am treat- 
ing, admits of the use of nutritious food. It should be limited 
in quantity — the patient should make a fair trial, by daily re- 
ductions of food, whether there is not an amount which he can 
digest without producing heartburn ; or feeling itlike an intolera- 
ble load on the stomach. If he can find this amount, a great 
point is gained. His cure is almost certain ; for time, with a 
cautious variation, and gradual increase of his food, in connex- 
ion with the remedies advised, will probably afford entire re- 
lief. But this trial should be made with articles best suited to 
the case, and easiest of digestion. 

Farinaceous grains form, in my opinion, the food easiest of 
digestion. The best mode of preparation is unquestionably by 
boiling; for this divides the pai tides most, and enables the 
gastric juice to dissolve each particle most readily. They 
should not be taken combined with too much water ; for this 
dilutes the gastric juice too much, hominy is better than gruel. 
Salt is the only condiment which should be added, for every 
other that I know, is either very indigestible, or very inflaming. 
This rule applies with great force, to Indian corn and rice. 
Flour is with so much coaxing, prepared into bread of so many 
kinds, that we have less experience of its effects when boiled. 
I believe strongly, however, in boiling. These grains are 



336 DYSPEPSIA. 

probably the best of all articles of food — they tire more nutri- 
tious, and of easier digestion than any other grain. These are 
important points, and I cannot give better evidence of this, than 
by recurring to my own experience. When I was a young 
practitioner, I took up or adopted the opinion, that animal food 
containing in itself the elements of nutrition already digested 
and animalized, would require less change in the stomach, to 
fit it for the purposes of life, and must, therefore, be easy of 
digestion. On this opinion I proceeded, and gave animal food 
in many cases where it proved indigestible, and did harm. 
Thinking it was too stimulating, I lessened the quantitity ; but 
it would not all do. I was compelled to see, that the bread 
stuffs above mentioned, were more easily digested than meat. 
And now having lost one theory, I have adopted another. 
Man draws his nutrition from every variety of food. He can 
digest a succulent vegetable, a farinaceous grain, or the flesh 
of an animal. His gastric juice is fitted for all these, but least 
perfectly for the two extremes — the grain containing the ele- 
ments of both the animal and vegetable kingdoms, is exactly 
the thing, and easiest digested. The dog, which is carnivo- 
rous, will digest the meat with most ease ; but the cow will 
digest the vegetable easiest, because she is herbivorous. 

I have said that the grains most used by civilized men — 
wheat, maize, and rice, are the easiest articles of digestion ; 
and that they are most easily digested when prepared by boil- 
ing. This is pre-eminently so with regard to rice, which by 
the common consent of all nations, is cooked in almost no 
other way. It is best when the water in which it is boiled 
is nearly all evaporated, leaving the rice nearly dry. 

Wheat flour is made into bread by fermentation and ba- 
king, by which its substance is divided into cell's. These cells 
are openings into which the gastric juice enters, and performs 
its office of digestion. If the bread is eaten when first baked, 
it is indigestible ; because the moisture of the mass causes the 
cells to close under the process of mastication. It is there- 
fore best stale, or dried by letting it remain in the open air, a 
day at least, before it is eaten. In this state, it is eaten with- 
out the particles uniting so as to prevent the action of the gas- 
tric juice. The same end is accomplished by combining the 
flour by hard kneading, with as little water as possible, into 
buiscuit or crackers. Baked in this state, the gluten of the 
flour does not unite into paste ; and the bread, comminuted 
by the teeth, is swallowed in a state to be easily penetrated by 
the gastric juice. Unbolted flour is used to accomplish the 



DYSPEPSIA. 337 

same end. The bran is wholly indigestible, and serves only 
the mechanical purpose of keeping the particles of flour sepa- 
rated. The increase of volume it produces, is thought to ope- 
rate beneficially in causing a greater flow of gastric juice from 
the stomach, and a stronger peristaltic motion of the bowels, 
thus at the same time favoring digestion, and obviating costive- 
ness. Such are the forms or states of wheat flour, best calcu- 
lated for food, for persons with defective digestive pow r ers : 
first, boiled into thick gruel or paste — secondly, baked into 
bread containing the bran — thirdly, in crackers or ship-bread, 
and lastly, into fermented, or light bread, eaten long after it is 
baked. 

Since writing the above, I have witnessed the superi- 
ority of boiled wheat, as an article of food in dyspepsia. This 
old dish is worthy of being again introduced on our tables. 
Take clean wheat and boil it, till thoroughly done. Season 
and eat it as if it were rice. It is agreeable to the taste, and 
entitled to high confidence. 

Maize or Indian corn, (it should be white,) is more oily, and 
less digestible than either wheat or rice. The best mode of 
preparing it is the most simple ; grind it very coarsely, divest 
it of its bran and finest meal, and boil till thoroughly done. 
This is small hominy, an article more grateful to the appetites 
of many than rice, and possessing a tendency to remove cos- 
tiveness, is often more beneficial tban most other food. To 
make bread, it should be ground finer, but not too fine. Sift 
from it the bran, and add water, with but little kneading — 
bake in an oven, or in thin cakes on a griddle. The whole pro- 
cess requires less than half an hour. This, to persons accus- 
tomed to it, is the most grateful of all bread- — field laborers 
would not exchange it for any other. It finds its place in the 
regimen of the dyspeptic, not because it is more easily digested 
than other bread, but because, to torpid bowels, it is a decided 
stimulant ; and in the absence of fever and inflammation it is, 
by many patients, easily digested. I have thought it unneces- 
sary to mention several other grains, which are used as food 
in civilized countries — rye, buckwheat, oats, and barley, may 
be made into bread ; and batter cakes of rye or buckwheat 
are, to many persons, agreeable. They are to be cautiously 
used by dyspeptic persons. 

To all these articles of bread stuff, I have said that salt is 
the only necessary addition. But in using them as food, the 
question of what may be taken with them, is constantly pre- 
senting itself. Close attention to the effects of these additions, 
22 



33S DYSPEPSIA. 

• 

should be paid by the dyspeptic and his physician. They 
should be taken in moderation at all times, but particularly so 
at the commencement of the treatment. Milk is far the best 
as a general rule ; but there are not wanting individuals who 
cannot use it because of its offensiveness to their taste ; and 
there are others to whom it is manifestly unfriendly. These 
peculiarities cannot be controlled — the article must be aban- 
doned in such cases. 

Animal food is never allowable, unless in conjunction with 
the breadstuff's above mentioned. The patient who can eat 
bread safely, may next add to it a little meat, or what is near- 
ly equivalent, butter. This last article, when fresh, is by far 
the best and lightest animal food. It should not be heated, or, 
at most, it should be only softened by heat. It is unfit for fry- 
ing, because of its readiness to become rancid by heat. Salted 
butter is also a good article, but it must be free from rancidity. 
Authorities, I apprehend, will be strong against my advice for 
the use of butter. Let it be borne in mind, that I advise only 
the butter recently made, or perfectly preserved from rancidi- 
ty. No article is worse than rancid oil ; and rancid butter is 
not much better. Let it be tried in its freshest and sweetest 
state. It is the only addition which the appetite demands, to 
the bread, rice, or hominy, I have above recommended. If it 
agrees with the stomach, the patient has in it the equivalent of 
animal food. 

Great pains have been taken, to discover the most digesti- 
ble animal food. The tables published, point out the least 
stimulating, as of easiest digestion. Small birds, and domes- 
tic fowls, especially those with white meat, are thought the 
best : next, venison, lamb, beef, and pork in their order. 
These are advised to be taken fresh. To this rule there are 
many exceptions ; and I am not certain that it is not altogether 
wrong. The flesh of birds and other animals, is made tender 
by letting it remain unsalted, for a time after being killed. 
What length of time this may require, it is difficult to decide, 
because it is shorter according to the heat of the weather. 
Twelve hours may answer for birds in summer, and a longer 
time for beef. If it becomes tainted, its digestibility is lessen- 
ed in due proportion. Salt, in sufficient quantity to hin- 
der this, should be added at the proper time. The sooner it is 
cooked after salting the better. This food and these rules may 
be varied to suit cases. 

I have expressed my doubts of the easier digestibility of 
fresh, than of salted provisions. I have no doubt of the fact, 






BY5PEF5 339 

that healthy persons are better fed on salted, than on fresh 

meats. Doctor I sample of the soldier of the Virginia 

:• threw away " his ration of choice fresh beef, and 

:n and six pence for a pound of salt meat," is but an 

pie of what I have many times witnessed in a less degree. 

that h: . the laborers of the South, has not 

witnessed their preference of a ration of salt bacon, over one 

fresh beef:" Who that has rations to an 

armv, has not made the same ol I have not only 

seen this, bu ime fact in my own family ; and 

we also witnessed the more important fact, that a higher 

^e of health prevails where salted provisions are ch: 
or altogether used. It is only those who take too little exer - 
who find no appetite for salted me 

The question between fresh and salted meats, is too important 
to be d ropped be re. If meat, prese rved b y ?etter for the 

healthv stomach, it is also better for one whose stomach, not 
inflamed, is in the state to digest only the food easiest as- 
similated. This is the state we are supposing our patient to 
be in. Food in his stomach, readily undergoes changes un- 
favorable to its conversion into chyle. I think I am not mista- 
ken in saving, that I have seen hundreds of persons rendered 

edtie, with heartburn, diarrhoea, flatulence, and pain in 
the stomach and bowels, from earing a variety of fresh pr : 
ions ; and who, on being put on an accustomed regimen of 
drv and salted provisions, were immediately restored to perfect 
health. 

These facts have had so much weight on my mind, that I 
have not scrupled to e patients salted meats, as soon as 

thev were in a state to use any animal food. I have allowed 
it to the anxious desires of many whose first wish, on the de- 
cline of an acute disr x of cold ham, or of dried 

son, or beef, eaten raw. The quantity of these article a 
of course, to be limited by the judgment of the physician. But 
if they disagree with the stomach of the dyspeptic, who takes 
them in moderation, he should delay the use of animal food, till 
he is better. 

:2b are the remedies which I have found most useful in 

epsia, in its ear. d before organic disease and 

fever have supervened. The same remedies are proper, in 
ma: . with other and more painful symptoms, than those 

I have described. Water-brash, or dyspepsia with frequent 
throwing or belching up of a watery fluid, especially in the 
morning, is successfullv treated with the tonic remedies above 



340 DYSPEPSIA. 

recommended. Spasmodic, or, as they are termed, nervous 
cases, require also the same remedies. But these painful ca- 
ses require some remedies, adapted to their peculiar symptoms. 
The presence of pain, especially if it is spasmodic, or attend- 
ed with cramp, directs the mind to opium, its great antagonist. 
In the cases of water-brash attended with pain, it has had 
most reputation. Acetate of morphine, in doses of one eighth 
to half a grain, has been given with great success. It has been 
thought, of itself, to have cured the disease ; but I should not 
advise a reliance on it, to the exclusion of other remedies. I 
should have equal confidence in laudanum, in doses of from 
ten to fifty drops, according to the intenseness of the pain. In 
cases attended with cramp, or spasm, and violent pain in the 
stomach, laudanum is an important remedy. It is to be given 
in doses according to the pain, even to a tea spoonful, if neces- 
sary. But in many cases, it is essential to rid the stomach of 
its offending matter, and if warm water in quantity does not 
effect this, ten or twenty grains of ipecac may be given. The 
preference given to ipecac in this case, is due to its producing 
the effect of vomiting, and freeing the stomach of its contents, 
in spite of the laudanum which may be necessary at the same 
time. 

But the frequent repetition of laudanum, may become a 
dangerous habit, and there are fortunately other medicines 
which will answer a valuable purpose, and are often preferable 
to this remedy. These apply more to cases in which the pain 
is less intense, but the flatulence, and perhaps despondency is 
greater. The first of these remedies which I shall mention, is 
water of ammonia, or what has been long in every one's hand 
under the appellation of hartshorn. From twenty to sixty 
drops of this may be taken in water, and repeated in half an 
hour, if necessary. Compound spirit of lavender, red lavender, 
is also a good remedy, and may be given in the same dose. 
Essence of peppermint, is, when prepared in the usual way, to 
be given for the same purpose in the same dose. Assafoetida 
is a valuable remedy in these cases. From four to ten grains 
of the gum, or from thirty drops to a tea spoonful of the tinc- 
ture, may be given, as often as the symptoms require. 

These remedies are given in vain, if the patient has not 
learned the control of himself. He should eat only twice in 
twenty-four hours, once in the morning, and again at early 
dinner. The long time between this meal and the next morn- 
ing's breakfast, is strongly objected to by some. My experi- 
ence is decidedly in favor of the two meals only ; and, in some 



DYSPEPSIA. 341 

cases, these are too many. All agree, that before a second 
meal is taken, the first should be digested, and passed out of 
the stomach ; but this admits of more than two meals a day; 
and I have no doubt, many cases will be well treated under an 
allowance of three meals a day, as nearly as may be — one 
in each eight hours. But in bad cases, I have found the third 
meal pernicious. 

Another rule is, to eat no more than the stomach will digest; 
and, by this means, avoid heart burn and its concomitants. 
Doctor Rush in his lectures, insisted on this rule, and related 
a case of extraordinary violence, which was cured by giving 
only a table spoonful of milk at a time, and nothing else. The 
same rule is still insisted on ; and, but for the difficulty of en- 
forcing it, dyspepsia would be shorn of half its force. Prrysi- 
cians should not be surprised at this. The appetite, which at 
first is altogether wanting, becomes at last morbid, and some- 
times ravenous. The fortitude which can, even under the ap- 
prehension of severe pain, resist such an appetite, is deserving 
of great commendation. Fluids should also be taken in mode- 
ration. Water, the best of all, often seems to bring on the at- 
tack, and I have no doubt is often a powerful cause in produc- 
ing the disease. Very little if any should be taken during the 
progress of digestion, or even during meals. This is a great 
but necessary privation. Let the patient try it and he will find 
the thirst, which is perhaps very distressing alter eating, pass 
entirely off, after digestion is complete. The benefit of for- 
bearance in such cases is very great. 

Exercise has been as much insisted on, as any other remedy 
for dyspepsia. It is generally advised when the stomach is 
empty ; but Doctor Beaumont came to the conclusion, that 
gentle exercise, on a full stomach, favors digestion. My own 
observation is in favor of rest after meals, especially dinner. 
Dyspeptic persons are uniformly rendered sluggish, or sleepy, 
by eating. Sleep, for a very short time, and quiet for three or 
four hours afterwards, gives to the digestive process its greatest 
force. This is the prudent course after dinner. But before 
dinner, the exercise should be as great as the strength of the 
patient will admit. The same may be said as to the evening. 
The exercise at these times, can hardly be too violent, if it is 
not continued too long. Travelling is a very defective mode 
of taking exercise. Many patients are rendered costive, and 
decidedly worse by travelling. But the rule does not hold in 
all cases — some are greatly benefited, whether by its good ef- 



342 DYSPEPSIA. 

feet on the mind, by the change in the mode and manner of 
exercise, or some other cause, is uncertain. 

TREATMENT OF THE INFLAMMATORY, OR LAST STAGE OF 

DYSPEPSIA. 

No one can tell the exact time at which a case of dyspepsia 
so changes its character, as to require a decided change of 
of treatment. When from long continued irritation of the 
stomach and intestinal canal, inflammation, or ulceration 
has happened, or a state very similar has occurred in distant 
organs — the liver, lungs, kidneys or others, dyspepsia becomes 
an inflammatory disease, and is to be treated as such. In this 
stage, the duodenum, or first intestine, which is so nearly con- 
nected with the stomach in its position and office, that it has 
been termed the second stomach, comes in for its portion of the 
affliction. This state of common disorder of the stomach and 
duodenum, will terminate what we have to say in our pres- 
ent chapter. 

A very short portion, " twelve fingers breadth," of the in- 
testine into which the lower orifice of the stomach opens, is 
called the duodenum. Into this portion, the bile and pancreatic 
juice enter ; and here, by universal consent, the process of pre- 
paring the food for its entrance into the living body, is finished. 
Here the chyle is separated from the chyme, and made ready 
to be taken up by the lacteals and caused to pass into the 
blood. The quantity of bile, which flows into the duodenum, 
is very great ; some estimate it at several pounds every day. 
This fluid and the pancreatic juice here mix with the chyme ; 
and there is good reason to believe, that they are not unfre- 
quently thrown back into the stomach to perform their office 
there. This was seen, so far as the bile is concerned, by Dr. 
Beaumont ; who found in his numerous investigations, that the 
stomach contained bile, especially when oily substances were 
present in it. This inter-communion of the contents of the 
stomach and duodenum, might well be expected to be attend- 
ed with an intimate connexion of their diseases. Not a doubt 
of this is entertained; and I fully believe, that the earliest 
stages of dyspepsia, often affect the stomach and duodenum 
in common, and desire that what I may now say in reference 
to the inflammatory stage of dyspepsia, may be regarded as 
equally applicable to both these organs. 

Recollect that it is the second, or inflammatory stage of dys- 
pepsia, for which we are now to point out the remedies ; and 



DYSPEPSIA. 343 

that this stage superadds to common indigestion, tenderness on 
pressure at the pit of the stomach, fulness, and sometimes 
swelling along the cartilage of the false ribs, and fever, more 
or less continued. These symptoms occur under many de- 
grees of mildness or aggravation, and are to be combated with 
the following remedies. 

1st. Leeches and gum water. — This celebrated prescription of 
Broussais, is applicable to the most formidable cases. The 
leeches are to be applied over the affected organs, on the ten- 
derest points. They may be applied from two to six at a time, 
and repeated, as circumstances require. I have said nothing 
of bloodletting, because leeching, the more popular, and now 
becoming the more common remedy, will answer. But I think 
bleeding often the more efficient, and convenient remedy. 
Blood may be drawn by cups, or by the lancet. The gum 
water is given here, not as medicine, but as food ; and 1 think 
it no where finds a more appropriate place. If the stomach 
can digest any thing, it is a little gum Arabic, dissolved in, or 
rather incorporated with, water. It is probably the easiest ac- 
tion of the digestive organs, by which nutrition can be obtain- 
ed. I may add, that experience fully sanctions it. How far 
this course is to be pursued, will depend on the strength of the 
patient, and the violence of the disease. I think it is easy to 
carry this process too far. We should remember that the in- 
flammation we are contending with, is ready to subside of 
itself, so soon as the digestive powers are restored ; and that 
the presence of food, if digested, will not hinder this salutary 
process. Then continue a regimen so poor as gum water, no 
longer, than the weakened digestive powers and keen inflam- 
matory symptoms continue. 

2. External stimulants. — Leeches and gum water have been 
mentioned, as applicable to the highest inflammatory state of 
dyspepsia. The irritation of the skin over the affected organs, 
is applicable to a more moderate, or longer protracted case. 
Several articles might be used in these cases. Blisters are 
first, and often best. They should be fully drawn, by allow- 
ing them to remain eight hours or more. Let them heal under 
dressings of mild ointment, or cabbage leaves wilted and ap- 
plied double. If the symptoms do not yield to a first applica- 
tion, a second should be made without too great loss of time. 
If the patient is very weak, or objects to blistering, apply tar- 
tar emetic ointment, made by rubbing two drachms of tartar 
emetic into an ounce of simple ointment or lard. Rub this on, 
once~a day, till light pustules are produced on the skin, and 



344 DYSPEPSIA. 

continue the application till the desired excitement is produc- 
ed. I believe the whole benefit of exciting applications to the 
skin, may be obtained by these applications ; but there is an- 
other, which seems in some cases to exert an action on deep 
seated diseases, not equalled by other remedies. This is io- 
dine in tincture — made by dissolving forty grains of iodine in 
an ounce of alcohol. Let this be applied with a feather daily, 
till blistering is effected. This remedy is so powerful in cer- 
tain affections of the larger glands, that a better could scarce- 
ly be desired ; but, in dyspepsia, I cannot say that I have 
found it superior to blistering, with the common ointment of 
Spanish flies. A trial may be made with it, when other reme- 
dies fail. 

3. Calomel — Costiveness, the common attendant of dyspep- 
sia, will of course demand the attention of the ptrysician, in 
the inflammatory stage. It is to be removed or prevented by 
the mildest means ; but it is not in reference to this symptom, 
that I now introduce calomel. The uses ol this remedy in dys- 
pepsia, are to be placed on higher ground — it is essential for 
the removal of some of the most fatal affections connected with 
this malady ; and justice cannot be done to patients who re- 
fuse to take it, or are denied its use. The exact circumstan- 
ces which demand the use of calomel, are not easily detected. 
I use it, without scruple, in all cases in which the inflammato- 
ry symptoms prevail; and, in many instances where they are 
scarcely to be noticed, I introduce it into the purgative reme- 
dies, it may be necessary to use. In a great majority of cases, 
it produces its accustomed mild cathartic effect, and especially 
that discharge of thick bile so peculiar to this remedy, and so 
grateful in its effect, of relieving a sense of fullness and op- 
pression in the region of the liver. As a general rule, I prefer 
not combining it w 7 ith other remedies, but give five grains of 
calomel, or ten of blue mass, at bed time. This dose should 
not be followed by any cathartic, if it produces one or two bil- 
ious passages in twelve hours ; and should not be repeated of- 
ten enough to endanger salivation, unless the case requires it. 

But there are many cases of dyspepsia, in which the bowels 
seem to reject calomel. I have seen a single grain operate for 
two or three days ; producing wasting, watery discharges, and 
great prostration. These cases are the most inflammatory, 
and, have no doubt had, a powerful effect in causing the fear 
of calomel which cannot escape notice, in the highest circles of 
practice. Shall we give calomel in such a case ? I say une- 
quivocally, yes ! Doctor Philip, I think, recommends half 



DYSPEPSIA. 345 

grain doses with opium, once or twice a day, till a very slight 
salivation is brought on. I advise this so far as the bowels will 
retain it, with the addition of friction with mercurial ointment, 
till the same end, a gentle salivation, is attained. This has, 
under my treatment, been the signal of recovery. My mind 
recurs, with vivid recollection, to a case of this kind. A gen- 
tleman of good constitution, but over-fond of eating, had la- 
bored under dyspepsia for many years, and had, for two sum- 
mers visited the most famous watering places. Returning from 
his last trip, worse than he set out, he placed himself under 
my care. I felt great embarrassment, from knowing that he 
bad been advised by the most experienced practitioners. He 
was greatly emaciated, and sallow; and a grain of calomel 
which I gave him, operated excessively, as he predicted. I 
drew about four ounces of blood from his arm. The blue se- 
rum which arose on the top, and remained fluid, did not lessen 
the doubt of the course I should take. I rubbed half an ounce 
of mercurial ointment over his abdomen, especially about the 
region of the liver and stomach. The skin w 7 as so irritated as 
to forbid the application again on the same surface. A day or 
two satisfied me that my patient was better. I repeated the 
bleeding in a little larger quantit}^, and again applied the oint- 
ment, but to other parts of the body. These remedies were 
persisted in for a month, before a slight salivation was brought 
on. But he was evidently improving. He lost blood twice a 
week. How could I fear the lancet, having so lately heard the 
eloquence of Doctor Rush in its favor? The salivation, though 
very slight, seemed to restore every function. The blood coagu- 
lated more firmly, and presented the buff coat of inflammation. 
He seemed to rise under the evacuation. He recovered in 
three months, having been bled more than twenty times, and 
used in frictions, several pounds of mercurial ointment. This 
case had lasted long, and was complicated, I thought at the 
time, with disease of the liver. But my patient denied suffer- 
ing the slightest pain or soreness, in the region of the liver, till 
after he was salivated — then a slight soreness in that region oc- 
curred. He recovered perfectly, lived many years, and never 
again required medical treatment for dyspepsia. 

I could relate other cases, in which calomel seemed to act in 
this equivocal way ; and yet, when properly used, proved the 
true remedy. In these cases, the effect of the remedy as a ca- 
thartic was hurtful ; because, from inflammation, or ulceration 
of the stomach, or some part of the bowels, its irritating quali- 
ties, or more probably, the mere motion of the bowels, could 



346 DYSPEPSIA. 

not well be endured. - The relief was not obtained, till a slight 
salivation was brought on. 

4. Nitre and tartar emetic. — Common nitre — nitrate of potash, 
is often very useful in the inflammatory stage of dyspepsia. 
There can be no doubt, that this article, when given in excess, 
is destructive of the digestive powers. This admonishes us to 
limit its use to its proper office, of reducing inflammation. To 
this end, I advise it in doses of from five to ten grains, from 
two to six times, in twenty-four hours. It should be given 
when there is much tenderness of the stomach on pressure, and 
especially to allay thirst. In cases in the highest degree in- 
flammatory, tartar emetic may be combined with the nitre. 
Take two drachms of nitre, and two grains of tartar emetic, 
and dissolve in half a pint of water. Give from two to four 
tea spoonsful, three times a day, lessening the dose, and choos- 
ing the most distant times from meals to administer it, if the 
remedy produces sickness at the stomach. 

5. Food — I have mentioned gum water, in conjunction with 
leeches, not that I think gum the only allowable food. Far 
from this ; I think the cases are rare, in which it will be neces- 
sary to make this the only food. But if it is relied on for this 
purpose, some attention is necessary to the quantity of the gum 
taken, and the time at which it is used. Like all food, it should 
be divided into meals ; and, in this case, the water given with 
it should be nearly all that is allowed the patient. But it can- 
not be forced on patients for too great a length of time, because 
it will become offensive to the appetite. 

Rice has all the advantages of gum — is about as easily di- 
gested, yields more nutrition, and admits of more variety in 
the mode of preparation. It is therefore the best food in dys- 
pepsia. 

It can hardly be requisite to mention the variety of mild ar- 
ticles of easy digestion, which might be properly allowed to 
patients, under treatment for this tedious complaint. It should 
be borne in mind, that in this inflammatory state of dyspepsia, 
the object is to furnish articles of easy digestion, and of mode- 
rate degree of nutritive properties. Fruits, if not too acid, are fre- 
quently as beneficial as they are grateful. They can be tried 
without danger, as their ill effects, if they produce any, are ob- 
vious in a short time. 

I have said nothing of the treatment of ulceration, or schir- 
rus of the stomach or duodenum. We have seen, that the 
presence of these disorders cannot always be known. They 
produce, it is true, great irritation of the stomach, with vomit- 



colic. 347 

ing, and sometimes diarrhoea. We have no specific remedies 
for these diseases. What better can we do, than to use the 
above mild and soothing treatment? Nothing that I know of ! 
Perhaps we hope relief from our remedies, and hold out false 
hopes to our patients. Would it be better at first to know the 
awful truths which time will soon enough disclose ? 



COLIC. 



Every acute pain of the abdomen, which is attended with 
constipations, and is at intervals greatly aggravated, may be 
termed colic. This is a wide range, and includes various dis- 
orders ; but it has been found impracticable to define each by 
itself, because of the intimate relation they bear one to another, 
and of the infinite complications they are subject to. Instead, 
therefore, of following the intricate windings of the nosologists, 
or the patient and laborious efforts of our cotemporaries, to de- 
velope by dissection, every disordered organ — and by chemistry 
every alteration of the component parts of the fluids or solids in- 
volved ; we shall be satisfied with the discussion of some of the 
most common forms of colic ; and by pointing out the most ra- 
tional and successful mode of treating these, enable the stu- 
dent to treat others, bearing the similitude so general in these 
complaints. For after all that can be attributed to the af- 
fections of particular organs, and the acknowledged impor- 
tance of knowing these special diseases in every case ; it must 
be confessed, that the investigation is more tedious than 
successful, and the knowledge sought for, not always of 
much consequence if known. If the skilful treatment of 
colic, depended upon an intimate knowledge of all the 
local disorders with which it may be connected, the fate 
of the sufferers would be deplorable. But I flatter my- 
self that I shall be able to point out a mode of investiga- 
ting and treating this disease, highly beneficial, if not per- 
fect ; and so simple in its details, as to render colic one of the 
easiest diseases to treat properly. To accomplish this, I shall 
so divide the subject as to enable the practitioner to prescribe 
according to the general character of the disease, without over- 
looking the attendant local disorders. I shall treat of this 
whole subject under three titles. Simple colic — bilious colic — 
and painter's colic. To these, all others bear so close an affini- 



348 colic. 






ty, and require such similarity of treatment, that I think it de- 
cidedly best to avoid a wider classification. 



SIMPLE COLIC. 






This disease occurs in persons apparently in perfect health ; 
but there unquestionably lies, far beyond our scrutiny, a foun- 
dation for it, in the temperament or constitution of the patient. : 
Many persons are subject to attacks of it, which cannot be at- 
tributed to any known cause. But it may also be produced ) 
by improper food, exposure to great vicissitudes of the weath- 
er, and other causes. It occurs most frequently in summer, 
and is epidemic in some tropical countries. 

The disease is ushered in by cold extremities, with free dis- b 
charges of air from the stomach or bowels. These symptoms di 
are followed by pain, most frequently across the abdomen near | oi 
the navel. The pain may extend to any part of the intestinal n 
canal and its associated organs, especially the liver. Violent j 
spasm or cramp is felt in the bowels and muscles of the abdo- n 
men. To the hand laid on the abdomen, every part feels rigid 
and contracted. Other and more distant parts become involv- 
ed. The shoulders are sometimes the seat of violent pain — 
the limbs are drawn up with cramp, and the patient seeks re- 
lief by violent pressure on the abdomen with his hands. These 
symptoms are sometimes considerably protracted. The pains 
lessen ; but the air, moving with noise in all directions in the 
bowels, becomes more inconvenient. The peculiarity of these 
cases, seems to be, the absence of inflammation, tenderness, 
or fever. But the paroxysm will at last give way — gradually 
the heat will return to the limbs, the stomach and bowels will 
cease to discharge air, and the spasm and pain of the bowels i 
will cease. A slight feverish heat will supervene, and soon 
pass off, for another but indefinite term of imperfect health. 

TREATMENT. 

Before a remedy is given, enquiry should be made as to the; 
cause which has brought on the attack. Has it arisen from i 
exposure to cold, and its effect, a checked perspiration — has 
the patient hernia, or any disorder of the bladder, kidneys, or 
liver — is it a disease common in the neighborhood at the time ; 
and above all, has the patient indulged in too free use of im- 
proper diet or drink? These, and other causes separately or 
combined, must betaken into consideration before a remedy is 
offered. 



colic. 349 

By far the most common cause of these attacks, is the im- 
proper indulgence in food too rich, or taken in too great quan- 
tity. In such cases, the disease not unfrequently results in 
cholera morbus, of which more will be said in the proper place. 
But should no effective vomiting take place, and a violent 
pain in the stomach be present, with good reason to suppose it 
is caused by the presence of undigested food, an emetic of fif- 
teen grains of ipecac in a little water, should be administered. 
If the patient is easily excited to vomiting, a glass or two of 
warm water may be used instead of a stronger remedy. A 
free and thorough discharge of the contents of the stomach, 
should, in this way, be effected. If the pain continues, a stimu- 
lant suited to the case may be given. A large class of reme- 
dies for this purpose is in the reach of every one. Essential 
oils of peppermint, cinnamon, lavender, and many others, 
may be mentioned. Tinctures of these, prepared by solution 
in alcohol, are sold under the name of spirits, or essences, and 
may be given for the relief of pain and expulsion of air from 
the stomach, in these cases. I recommend the following, or 
either of them. Compound spirit of lavender may by given 
in doses of from thirty drops to a tea spoonful, repeated in half 
an hour, if necessary. Essence of peppermint in doses of 
twenty to sixty drops. These, and other similar remedies, 
may be given w r hen the disease is very slight, or in its form- 
ing state. They are sometimes sufficient to remove the pain, 
and I have no doubt, in many cases, to ward off the attack. 
But if the pain becomes violent, let no time be lost in adminis- 
tering opium in some form. Laudanum in doses of from thir- 
ty to one hundred drops, may be given, and if no relief is felt, 
in an hour or two, repeated. This remedy, against which 
there is great prejudice in the minds of many, is our great re- 
liance for relief in this excruciating disorder. Let no fear of 
ill consequences hinder its administration. Do not readily 
credit the belief which the patient may happen to entertain, 
that opium disagrees with his stomach. I have, in more than 
thirty years, met with but one case in which opium seemed to 
be incompatible with the constitution, or temperament of the 
patient. In the mean time, I have administered it success- 
fully to hundreds, who from apprehension of this kind, took it 
with fear and trembling. The pain, or rather the agony, 
which thousands now daily suffer, from the want or too timid 
use of this invaluable remedy, can hardly be conceived. I am 
far from underrating the ills of the habitual use of opium. 
They are fearful, but colic is not one of them. I have never 



350 colic. 

treated a case of this disease in an opium eater. They are not 
subject to it. I have perhaps said too much in favor of this 
remedy. If I have, it has been caused by the conviction, that 
in the hands of the best practising physicians of the day, not 
half the use is made of it that ought to be ; and I have no hesi- 
tation in saying, that the patient who is suffered in this disease, 
to writhe in agony from hour to hour, and not allowed the bene- 
fit of opium in some form, cannot discharge his physician too 
soon. Another remedy against which there is a better founded 
prejudice, is alcohol in the form of good spirit. Great is the 
cause for regret that this article ever found its way out of the 
laboratory of the chemist, or the custody of the druggist and the 
physician. Like other blessings of Providence, its cheapness 
has led to its great abuse ; but I trust the habitual neglect of 
its common use, will in no great length of time restore it to the 
healing art, where it properly belongs. In the use of this 
remedy, more discretion is necessary than in the use of lauda- 
num. It is more to be feared when the case is inflammatory, 
especially, if the inflammation is of long standing in a particu- 
lar organ. But in the appropriate cases, it is decidedly supe- 
rior to laudanum, or any other remedy I have yet seen. In 
cases of threatened attack, where, after a hearty meal, or some 
article taken which is hard of digestion, the patient finds him- 
self throwing off volumes of air, his feet become cold, and 
slight pain begins to be felt in the stomach or bowels, a glass 
of brandy and water, about a table spoonful of brandy where 
it is not habitually used, is the best of all remedies. One 
fourth part of the quantity taken at the time of eating, would 
have hindered every ill consequence. But even after the at- 
tack has come on with violence, if there is no opium or lauda- 
num at hand, brandy, or other good spirit, may be substituted 
with great advantage. Thus far nothing has been said of the 
removal of acid from the stomach. The earths and alkalies 
which neutralize it in the stomach, should never be forgotten. 
The presence of acid is always to be suspected ; and where the 
case is so mild as not to call for the use of an emetic, some one 
of the neutralizing remedies should be used. This is not to be 
neglected, because the patient is not sensible of the presence 
of acid in the stomach. Some persons are never sensible of 
this, except they are made to throw it up — in language perhaps 
more generally understood, they never have heart burn. But 
this acid is, in many cases, a leading cause of the pain; and a 
remedy to remove it, is often attended with immediate relief. 
Sixty grains of prepared chalk, a piece about the size of an al- 



colic. 35 L 

mond, may be eaten, or taken in an}' convenient way. More 
or less may be taken, and repeated, as often as it is found ne- 
cessary — the article being inert when it meets with no acid to 
combine with, and when it does, producing the least offensive 
compound of all others. For this reason, it is, in the hands of 
common persons, the safest of remedies. Magnesia is also a 
remedy for this disorder of the stomach. When combined 
with the acid it meets with in the stomach, it forms a mild 
cathartic , and when this effect is desired, this article may be 
chosen. I advise the following combination : — Take of pow- 
dered rhubard, 30 grains — calcined magnesia, 60 grains — 
mix and divide into four powders. One of these powders in 
water, may be taken and repeated as called for. The magne- 
sia may be taken separately in larger doses — a tea spoonful in 
water — and repeated without fear. Its only effect, after neu- 
tralizing the acid, is to act as a gentle cathartic ; and the great- 
est fear is, that from its temporary good effect, the patient may 
indulge in its use too frequently, to the injury of the digestive 
powers. Lime water is also a certain remedy, to remove 
acid from the stomach. A table spoonful in a glass of water, 
may be taken at two or three doses in a few minutes, the pa- 
tient being cautious to desist when the presence of acid is no 
longer felt. Used in this way, I have never known any great 
inconvenience attend the use of lime water ; but there are rea- 
sons against relying on it. The quantity taken should not ex- 
ceed the power of the acid in the stomach to neutralize it. The 
lime, in that case, might be a worse caustic than the acid it is 
given to remove. Another objection to lime water, is the diffi- 
culty of preserving it, of a given strength. The two fixed al- 
kalies, soda and potash, are first rate remedies here. In this 
state of preparation, these two alkalies are mild enough to be 
safely taken into the stomach, even when there is but little 
acid present. From ten to twenty grains in water, may be 
given, and repeated, as they are required. The volatile al- 
kali — ammonia — or, as it is commonly called, hartshorn, is 
also a remedy for acid stomach. Its use is to be more guard- 
ed, because it is of itself a powerful stimulant. It is not often 
necessary to resort to it ; but when the use of the common al- 
kalies has failed to relieve the oppression, discharge of air, hic- 
cup, and other spasmodic attendants of this disease, a few 
drops of this remedy in the form of water of ammonia, or spirit 
of hartshorn, will often give instant relief. From twenty to 
sixty drops may be given ; and, after half an hour, repeated, 
if necessary. There are cases, most frequently met in preg- 



352 colic. 

riant women, in which the acid on the stomach does not yield 
to the neutralizing powers of any of the remedies we have 
mentioned — to the surprise of those who understand best, the 
chemical relations of the contents of the stomach, and the 
remedies thrown into it. Still greater is the surprise, at find- 
ing tartaric acid or lime juice, a remedy in such cases. Lem- 
ons commonly furnish the best remedy, and should be used 
without too much sugar. The juice of a hard apple, obtained 
by chewing, I have found, in some cases, a first rate remedy. 
These articles may be tried, in cases in which the remedies 
first mentioned, seem to do no good. 

The paroxysm of this form of colic, is commonly relieved, 
before the bowels are operated on ; but, in other cases, the 
pain continues till the bowels are thoroughly evacuated. Jn 
reference to this fact, calomel should almost always be admin- 
istered, at the same time the laudanum or opium is given. It 
will not hinder the beneficial effects of the opium, and twelve 
hours or longer after its administration, it will prove the surest 
reliance, for the thorough evacuation of the bowels. If, in ten 
or twelve hours, the calomel does not operate of itself, some 
brisker cathartic should be administered. Castor oil, in doses 
of from one to two ounces, is the best, if it will remain on the 
stomach, and can be made to operate. Salts and senna are 
by far more powerful ; and, in difficult cases, the surest reli- 
ance. I give it as follows : take of senna leaves half an ounce, 
Epsom salts two ounces. Pour a pint of boiling water on the 
senna, keep it warm by the fire for fifteen minutes, and then 
strain it off, and add to it the salts. Of this, a wine glass full, 
about two ounces, may be taken hourly, with more cer- 
tainty of procuring free discharges from the bowels, than any 
or every other cathartic I have seen tried. Other cathartics 
may answer as well ; and, where they are more easily obtained, 
may be used ; but in all cases where a free discharge is brought 
on, particular care should be taken to preserve the strength of 
the patient, if there is much weakness present. This is best 
done by small quantities of brandy and water — if there is still 
much pain, laudanum, repeated according to the urgency of 
the symptoms, should not be forgotten. 

Sinapisms — stimulating plasters and warm fomentations, and 
even the warm bath, I consider temporary, and at best but 
secondary remedies. Where the pain is violent, they may be 
used, and. I frequently advise them as auxiliary remedies to 
the more powerful agents I have been describing. Injections 
are to be placed in the same class. I will repeat an observa- 



; 



colic. 353 

lion I heard made by Doctor Rush. " An injection is a broom 
in the hand, with which a poor attempt is made to reach up, 
and sweep down the soot from the chimney ; a cathartic is a 
chimney sweep, who begins at the top, and clears out every 
thing before him." 

The paroxysm having terminated, the physician should not 
be too anxious to do more for his patient. If some fever su- 
pervenes, a little time, with abstinence and the undisturbed 
operations of nature, may be safely relied on. If the inflam- 
mation of the kidney, liver, or any other organ which may be 
diseased at the time, is increased, the same rule holds good — 
let the patient have a few days' rest from remedies. But let 
all the usual means of preventing a paroxysm, be diligently 
practised, when the patient rises from bed. Let constipation' 
and indigestion be carefully avoided. Let exercise be regular- 
ly taken, but avoid with the greatest care, sudden exposure to 
cold and suppressed perspiration. The skin has an important 
office to perform, in this disease, as well as others. The cold 
extremities attending the attack, may be considered a mere 
symptom of the disease, and depending on it. But the fre- 
quent occurrence of attacks, obviously brought on by being 
caught in a rain, or by getting the feet wet, leaves no doubt of* 
the deleterious effects of a sudden suppression of perspiration. 
Sensible of this, I have advised the wearing of flannel next the 
skin, and shoes and stockings warmer than those usually worn. 
In one case, where these seemed insufficient, and the patient 
still had his attacks ushered in with cold feet, I advised a piece 
of felt or hat, worn in the shoes, and the case was relieved. 

COLIC IX IXFANTS. 

These cases present the simplest form of colic. The stom- 
ach now for the first time, being called on to digest food, should 
have presented to it only that which is exactly suited to its 
powers. The milk of a healthy mother is exactly the article ; 
but subject to deterioration from so many causes, such as ill 
health, bad food and bad drink ; that it is not wonderful that 
the child is hardly nursed before its stomach is tormented with 
pain and spasms. The same effect, no doubt, as often happens 
from defects in the digestive powers of the child. Improper 
food given to the little stranger, is a frequent cause ; and ex- 
posure to cold and dampness must be regarded in the same light. 
Costiveness is also a frequent attendant, and probable cause of 
this disease. All these causes suggest the proper remedies — 
23 



354 colic. 

the mother's health and the child's comforts must be provided 
for, and the indigestion, pain, constipation, and flatulence, re- 
quire nearly the same treatment with the same symptoms in 
grown persons. But the tender age of the patient, suggests 
the necessity of greater caution; and we shall, therefore, dwell 
a little on the treatment of infantile colic. 

The violent screams of the little sufferer — the coldness of its 
hands and feet — frequent discharges of air from its stomach 
and bowels — the drawing up of its legs, and the spasm of its 
abdomen, easily felt on pressing on the part with the hand, 
sufficiently point out the disease. The attack is to be met 
with remedies to expel the wind, and remove the spasm from 
the stomach. A tea spoonful of brandy, with a little sugar, 
and four times its volume of water, may be mixed and given in 
doses of a tea spoonful every fifteen minutes, if necessary, till 
two or three doses are given. Four grains of prepared chalk 
in syrup, may be given to correct any acid the stomach may 
have on it. If no relief is obtained, the essences of lavender, 
cinnamon, or peppermint in sugar and water, may be given. 
Three or four drops of either of these may be given, from time 
to time. These remedies will hardly fail to relieve the pain in 
a short time ; but they do not always effect it, and resort must 
be had to paregoric or laudanum. Six drops of paregoric, or 
one drop of laudanum, is a dose for a child of a month old or 
less. This remedy is to be resorted to only when others fail, 
but then it may be used with great safety and success. The 
great objection to it, is the temptation its soothing powers give to 
the too frequent use of it, by nurses or mothers. From the 
apprehension that vomiting might bring up from the stomach, 
such large portions of curdled milk, as to be in danger of 
strangling the child, I have not prescribed emetics. During 
the attack, I believe a child never throws up its milk — the 
violent and spasmodic contractions of the stomach, expel only 
wind. Yet, at other times, and in other disorders, curdled 
milk, sometimes very hard, is thrown up. 

In the intervals of the attacks, remedies are still to be used. 
The following prescription I have given with great advantage : 
Compound tincture of gentian, one ounce and a half; com- 
pound spirit of lavender, half an ounce. Mix these together, 
and to a child a month old, give ten drops in water, four times 
a day. Twenty drops of brandy in sugar and water, may be 
given five or six times a day, for the same purpose ; but it is 
far inferior to the gentian. The variety of spices and vegeta- 
ble tonics, which may be beneficially given in these cases, is 



colic. 355 

very great. Ginger, calamus, allspice, and the bark of several 
trees, such as wild cherry, poplar, and others. There is no 
benefit in changing from those I have recommended, to any of 
these. If, by these means, a perfect digestion of food is 
brought on, the bowels will probably take on a healthy action ; 
but there are many cases in which costiveness in infants, be- 
comes of itself very troublesome, and lequires remedies for its 
removal. In slight cases, injections of soap and water, or a 
piece of soap reduced to a size little larger than a quill, and 
forced into the anus, will cause a passage from the bowels in a 
few minutes. These means proving of no effect, purgative 
remedies should be given. Rhubarb is probably the best. 
Four or five grains in water are not too much for a cathartic 
for a child a month old — half the quantity might move the 
bowels gently. Where an acid stomach with feverish symp- 
toms, is present, give the following : Take of rhubarb, six 
grains ; calcined magnesia twenty grains ; mix and divide in- 
to four powders, one in water to be given from time to time, 
according to circumstances. These remedies should not be 
persisted in longer than their absolute necessity is obvious. 
The child should, as soon as possible, be delivered over to na- 
ture, its great conservator. 

BILIOUS COLIC 

This variety of colic is discriminated from other kinds, by 
the fever, and tenderness, or inflammation of the intestines, 
which attends it. It is commonly brought on with a chill, ma- 
king its attack most frequently in the night, and commonly in 
the heat of summer. It is attended with irritability of the 
stomach, vomiting of bilious matter, pain of the abdomen, 
cramp in the muscles of the belly, and in the intestines, and 
frequently extends to the limbs. In this state of agony, a cold 
perspiration bedews the whole body ; paleness, or rather a ca- 
daverous yellowness of the face, with the expression of intense 
pain, points out the serious nature of the malady, with which 
the patient is attacked. Gradually a feverish heat is felt over 
the abdomen, and it extends by degrees to the whole body. 
The pulse, small and quick at first, becomes full and corded ; 
and the face no longer pale, is flushed and burning with heat. 
The bowels are obstinately costive ; and, if no relief is ob- 
tained, the irritability of the stomach, and vomiting increase; 
and the patient, after the most harrassing affliction of several 
days, expires. In a few cases, the vomiting increases, the ac- 



356 colic. 

tion of the whole intestinal canal is inverted, constituting what 
is termed ileus; the whole contents of the bowels are discharged 
by the mouth, the case is protracted, local seats of inflammation 
may be detected by carefully examining the abdomen, and 
some times an unexpected hernia found in a strangulated 
state. These symptoms, without relief, lead also to a fatal ter- 
mination. 

TREATMENT. 

My experience in colic would not allow it a place amongst 
very fatal disorders. Allowing all that can be claimed for the 
best mode of treatment, I am still left to think that it is, in my 
neighborhood, a comparatively mild disease. Ileus I have 
never seen, and fatal cases of colic I have very rarely seen. 
But I have often treated bilious colic, with very formidable 
symptoms ; and I offer my mode of treatment with some con- 
fidence. 

When called early to cases of this disease, I lose no time in 
administering twenty grains of calomel, with three or four grains 
of opium made into pills. A grain of morphine may be advanta- 
geously substituted for the opium. If this remedy is retained, 
I give nothing more for twelve hours. I then give two ounces 
of castor oil, and repeat it every two hours, till free evacuations 
by the bowels are brought on. If at this time, the case seems 
formidable, I lose no time with castor oil, but prepare my fa- 
vorite remedy, salts and senna, and give it, in broken doses, 
as advised in common colic. Under this treatment, cases sel- 
dom last beyond the second day. But in cases with manifest 
fever, and tenderness of the abdomen, bloodletting, at the out- 
set, is necessary. If the nausea is distressing, and the pills re- 
jected, and there is, at the same time, a considerable fever, give 
tartar emetic in half grain doses, at intervals of half an hour, 
till a free emetic operation takes place. This will probably re- 
duce the nausea, lessen the tenderness of the abdomen, and 
render the operation of cathartics more easy. Some times it 
happens, that when medicines have fully discharged the con- 
tents of the bowels, the pain yet remains, nearly as bad as 
ever. This will indicate the presence of inflammation, com- 
monly, of the small intestines. This is to be treated with more 
regard to the local symptoms. I should approve of leeches on 
the tender points, and cupping as near them as it could readi- 
ly be borne. But I have oftener resorted to blistering, and 
have had every reason to be satisfied with its effects. Cathar- 
tics should not be persisted in, in these cases, but three or four 



colic. 357 

grains of calomel daily should still be given. It is a great mis- 
take to change this article with irritating the bowels. Whether 
it be from its operation on the liver, causing it to throw into 
the intestines a mild bilious secretion, or from any other cause, 
it has never, in my hands, seemed to increase the tenderness 
of the bowels. On the contrary, it has, in all cases of inflam- 
ed bowels, appeared to me the mildest and most soothing of all 
cathartics. Should the case become protracted, and the small 
doses I advise, be continued for several days, a salivation may 
be induced; but the danger of such cases, does not justify any. 
hesitation in the matter. A salivation is a small evil, when 
compared to the consequences of these uncured inflammations 
of the bowels. 

I have not mentioned the tithe of the remedies which have 
been used in colic. I think, however, I have mentioned those 
which are best, and those which will prove sufficient. I have 
not mentioned fomentations, or injections. The first may be 
useful in allaying pain, and the last, however feeble, may se- 
cure the operation of cathartic medicines, when without its aid 
they would require a longer time, and possibly fail altogether. 

Ileus is so alarming a symptom, that it should arouse every 
energy, and call forth every remedy. It occurs as well in oth- 
er forms of colic, as in that we are now treating. It admits of 
a longer continuance, than the disease when attended with 
constipation. I have said that in this case, the contents of the 
whole intestinal canal are throw T n up in vomiting. The char- 
acter of these matters, especially their ofFensiveness, is so ea- 
sily known, that further description is unnecessary. On ex- 
amination, there will be found in the abdomen great tenderness 
of some particular part, and probabry a tumour, more or less 
defined in its extent. Dissections have show 7 nthat these symp- 
toms arise from invagination, or intussusception of some por- 
tion of the intestinal canal. This is a portion of the intestine-, 
drawn like the inverted finger of a glove, into another portion. 
This may happen in the upward or downward course ; and, so 
far as I know, produces the same symptoms in each case. It 
is sometimes very slight, extending an inch or less; but I have 
seen nine inches of intestine drawn out of another, from where 
it had been thus thrust or drawn in. 

The sufferers in ileus, like those in infectious diseases in 
barbarous countries, seem to have been the subjects of every 
rash experiment which the mind of man could devise. Al- 
though the case is often fatal, the patient seems tenacious of 
life- He lives against reason and against hope, and his phy- 



358 colic. 

sician goes on from one expedient to another — -pounds of shot 
have been given as a remedy— crude mercury has long been 
celebrated, and is given without limit — injections of tobacco, 
or tobacco smoke have also been frequently tried ; and to 
crown all, the surgeon has opened the cavity of the abdomen, 
to unravel with his hands, or cut loose with his knife, these 
knots and entanglements of the bowels. Yet in spite of these 
fearful remedies, amongst which tobacco stands on a " bad 
eminence," the patient has frequently survived. They have 
survived I fear not often, the surgeon's knife, the mercury of 
the apothecary, and the lead, or rather the shot of the hunts- 
man. Even the poison of tobacco, at times fails to extinguish 
life. Even nature has in this case imitated successfully the 
rashness of the surgeon. A portion of the intestine which has 
been drawn within, and strangulated, has in several cases, been 
known to slough off, and be voided by stool ; and, strange to 
tell, the intestine has healed and the patient recovered. There 
is then, hope in ileus. But I am far from thinking that this 
hope is strengthened by the rash means above spoken of. So 
soon as the evacuation of the bowels, either upwards or down- 
wards, takes place, the sudden death from mortification, or 
constipation, is less to be feared. The physician should re- 
member this, and allow to nature some time to rectify her dis- 
ordered action. In ileus, he should remember that he has no 
remedy whose direct agency is known to change an inverted, 
to a natural motion. The structure of the intestines, seems to 
provide for a regular motion, to forward and expel their con- 
tents. Their inverted motion has, as yet, neither been ac- 
counted for, or controlled. It seems, I believe, always to be 
attended with local inflammation. The removal of this would 
seem to be the appropriate remedy. The restoration of di- 
rect, in place of the inverted action, must be left to nature. I 
should be sparing in the use of cathartic, medicines, not only 
because they, in cases of ileus, will probably be thrown up, 
but because I should have most hope from the greatest possi- 
ble state of stillness and quiet, which could be produced for 
the bowels. To this end, I should, by all means, reduce the 
inflammation by bloodletting, to the extent of the necessities of 
the case — the better if drawn in small quantities, or by cups or 
leeches. Applications of cold, by ice or cold water over the 
abdomen, deserve atrial. Injections of cold water, have also 
been recommended. Calomel and tartar emetic, the great 
means of combating inflammation, are to be used here with 
the greatest caution, Yet I could not attend a protracted case 



colic. 359 

of this kind, without giving them a trial. Both these remedies 
are to be given for their constitutional effects, and may be used 
combined or separately. 

Take of calomel twenty grains, tartar emetic four grains ; 
mix, and make them into sixteen pills. One of these pills to 
be given every two hours ; and if they lessen the vomiting, 
continue them till all are taken, or relief by downward pas- 
sages is obtained. Jf an increase of sickness at the stomach 
attends their use, stop them, and make other pills without the 
tartar emetic, but the same quantity of calomel. Let these be 
tried, without any added cathartic. These remedies may seem 
feeble ; but let it be remembered, that they are not given to 
force a passage in obstructed bowels, but to restore regular, 
and alter disordered action. And finally, in regard to this 
form of colic, let all things be done, with deliberation, and a 
full sense of the necessity of allowing the operations of nature 
to proceed, with the least possible disturbance from remedies. 
When the inflammation is subdued, remedies are no longer 
called for. The remarkable recoveries recorded, have owed, 
less to art than many of their reporters would willingly allow. 



This form of colic arises from the poison of lead, and, in the 
outset, is not easily distinguished from other varieties ; but in 
protracted cases, paralysis of the arms, and sometimes of oth- 
er parts of the body, sufficiently distinguish it. For a long- 
time the epidemic colic of certain districts in England, in 
France, and in Spain, as well as in the West Indies, and the 
United States, was thought to be identical with the painter's 
colic of the great cities of Europe. The poison from lead, 
known to be the cause of it in cities, was supposed Jo be de- 
rived in the country from certain drinks, such as cider or beer, 
which had somehow been incautiously kept in vessels compos- 
ed in part of lead. Closer investigation has demonstrated the 
fallacy of this opinion ; for it appears that no such use is made 
of leaden vessels as to account for the phenomenon, and that 
the disease occurs equally in those who use none of the drinks 
charged with such pernicious consequences. The paralysis 
too, which arises notoriously from the poison of lead, does not 
occur where this cause is wanting. 

The disease, as a distinct species of colic, is not readily 
known by its first symptoms ; but it is to be suspected if per- 
sons, who, from their trade, are much exposed to the influences 



360 colic 

of lead, are attacked. The persons most exposed are painters, 
plumbers, and miners, or smelters of lead. I have seen sev- 
eral cases in printers arising, as I suppose, from the lead which 
is a component part of the types their occupation requires them 
to handle. Doctor A. T. Thompson has labored to shew, that 
the carbonate of lead is the form of that metal most deleteri- 
ous, if it is not the only form in which it is capable of produc- 
ing painter's colic. By far the most dangerous exposure is that 
of the painter, who paints the dead white, made of white lead 
combined with a large portion of spirit of turpentine. Expo- 
sure to this volatile compound in close rooms, is the cause of 
many cases of painter's colic. Families venturing into newly 
painted rooms, are frequently thus diseased. But it will be 
unwise to reckon on safety in the use of other preparations of 
lead. I have known a fatal case of painter's colic brought on 
in a child, by its eating a piece of red sealing wax ; and an- 
other from raspings of lead administered for worms. Yet I 
have often prescribed the acetate, or sugar of lead, in consid- 
erable doses for a length of time, and never had a case of this 
disease arise from it. I have been equally fortunate in its ex- 
ternal application in solution, or combined in ointment. So far 
as my own experience goes, I must say that sugar of lead, used 
internally or externally, is a safe and valuable remedy. But 
to return to our mode of forming a judgment of the nature of 
the attack. The probability of an attack of painter's colic, is 
in proportion to the susceptibility of the patient, and the expo- 
sure to the causes we have- pointed out. 

The symptoms are plain enough, if well considered, to guard 
us against an improper prescription. Pain, and a sensation of 
weight about the pit of the stomach ; general langour and weak- 
ness, cold clammy skin ; weak pulse ; coated and tremulous 
tongue ; and, sometimes at the outset, a diarrhoea. These 
symptoms are mild, and may continue for some time, but 
they are rendered intense by any exciting cause. Exposure 
to cold or wet, even of the feet ; excess in eating or drink- 
ing, or any undue excitement, seems to bring on the attack 
with all its force. The pain now becomes violent— the mus- 
cles of the abdomen contracted — the bowels, drawn as it 
were, into knots, no longer allow any thing to pass them — 
the spasm ceasing for a moment, allows the movement and 
roaring of contained air, which I have seen more remarka- 
ble in this, than in other forms of colic. The abdomen is rath- 
er gaunt than distended, and the patient, pale, haggard, and 
exhausted, presents a peculiar aspect of misery. The attack, 



colic. 361 

at first, is usually unattended with fever; and, so far as inves- 
tigation has enabled us to decide, less inflammation in its whole 
course, than any other form of this disease. But if the attack 
is not arrested, a low fever supervenes, a jaundiced look, quick 
pulse, and hot skin seem to point out the liver as a suffering or- 
gan. The symptoms often become alarming, vomiting, hiccup, 
thirst, and tenderness of the region of the stomach, come on, 
but are attended with less danger than might be expected. In 
some cases, there is a calm and undisturbed state of mind, but 
more frequently, the brain and nerves seem to be greatly dis- 
ordered from the first. Headache, vertigo, stupor, and some- 
times delirium, come on. In more violent cases, convulsions, 
which may continue for many hours. A temporary blindness 
is sometimes added to the miseries of the attack. The rest- 
lessness and contortions of the body, perhaps, are carried far- 
ther in this than in any other form of colic ; yet, in all this, there 
is not much danger of immediate dissolution. 

These symptoms of disease, violent and intolerable as they 
are, seem but to lead the way to others more awful. Palsy, 
first in the arms, and next in the lower extremities ; emacia- 
tion, or shrinking of the limbs affected, and a drawing, or dis- 
tortion of the parts in various ways ; yet, in all this, the mind 
of the sufferer seems to remain unsubdued — his intellect ex- 
cept for a short time is clear and unclouded. 

The organic derangements which these symptoms seem to 
point out, are in fact not present. The intestinal canal shows 
to the dissector no structural derangement. The nerves pre- 
sent their healthy appearance, and perhaps in this more than 
in any other disease, examinations after death have disappoint- 
ed the dissector. Yet our limited knowledge, in this case, with 
no obvious disease of the brain, or nerves, compels us to call it 
a nervous disease. Its manifest symptoms compel us to charge 
the nerves with the burthen of the affliction, but we cannot 
find the proofs of it by dissection. 

TREATMENT. 

Doctor Dunglison says that the treatment of this form of 
colic differs from others, chiefly in the greater use to be here 
made of opium. And here I might, without much danger, leave 
the subject, recommending the same treatment I have offered 
in other cases. But it is well to suggest, that the local inflam- 
mation common in other forms of colic, being absent here, 
there is a general license in the use of stimulants and tonic 



362 colic. 

medicines. To relieve pain, evacuate the bowels, and sustain 
the strength, are the first objects of the treatment. A pill of 
a grain of morphine and ten grains of calomel, is the best pre- 
scription. Too much hurry and precipitation is to be avoided. 
Give time for the medicine to operate, and do not expect large 
doses to produce corresponding powerful effects. Go on pa- 
tiently but steadily with the ordinary means of removing cos- 
tiveness, and exciting torpid bowels. Let pills of aloes and 
gamboge or croton oil, have their place here, rather than in 
other cases of colic. But fail not to persist in the use of these, 
or similar means, till free discharges are brought on. After 
this the frequent use of laudanum or morphine, may become 
necessary. Let them be used without fear of ill. They may 
be necessary for a considerable time, but not a life time. I 
offer no proof of the fact, but I always think while time is 
sometimes consumed apparently to little purpose; nature is 
insensibly, in her own "cunning" way, throwing off the poison 
from the system. Support your patient by ever}' means, and 
relieve him from pain if in your power, and depend on nature 
to throw off the poison. 

Chemistry ought to furnish the means of neutralizing and 
destroying the poison of lead in the living body, and many pre- 
scriptions have been used with this view. The compounds 
containing sulphuric acid, seem best calculated for this pur- 
pose. They have been fully tried and found wanting. Alum, 
one of these, has of late been published as a remedy. It is 
offered in doses of sixty grains, three or four times a day. I 
have had no opportunity of testing it, but think it worthy of a 
trial. 

The paralysis which attends, or follows painter's colic, re- 
quires no particular treatment. If it attacks, as it frequently 
does, the flexor muscles of the limbs, splints and bandages 
should be used to preserve their form and straightness. Sina- 
pisms, or tartar emetic ointment along the spine, or blisters 
near any point of great tenderness, will be beneficial ; but the 
great reliance is friction, and frequent warm bathing of the 
limbs affected. Under this simple course, there is reason for 
great hope in cases, very unpromising in their appearance. If 
no relief is obtained, strychnia, a powerful drug, has been found 
a valuable remedy. Dissolve a grain in a few drops of alco- 
hol or spirit, and make it into twelve pills. Begin with one 
three times a day ; and increase, in the course of three or four 
days, to six pills, or half a grain. I have given it in larger 
doses without producing any ill effects. 



CHOLERA MORBUS. 363 



CHOLERA MORBUS. 

The attack of this disease is commonly sudden. Vomiting, 
purging, griping pains, and spasms of the muscles of the ab- 
domen, and of the extremities, compose the most common 
symptoms. It is a disease of more violence than danger, and 
is commonly the effect of improper food taken in too great 
quantity. It is sometimes epidemic, appearing in the last days 
of summer, and has, in our time, spread as a dangerous pes- 
tilence regardless of season, over a great part of the world, 
making its invasion of Europe from the East, and of this coun- 
try from Europe. 

There can be no use in dividing this disease into a great 
number of varieties; whether it arises from errors in eating, 
or from the excessive heats of summer, it is, in its symptoms 
and treatment, essentially the same. The common, or spora- 
dic cholera, in grown persons, and the same disease in infants, 
may include the whole subject, except the Asiatic or pestilen- 
tial, which will be separately considered. 

The cholera morbus is most prevalent in summer, when it 
frequently occurs as an epidemic, attacking persons who were 
in good health, and guilty of no particular imprudence. Vom- 
iting, purging, and griping pains, occur nearly at the same 
time. As the disease goes on, the pain increases, extending 
to the limbs, which are affected with frequent cramp, or per- 
petual spasm. The discharges by vomiting, and by stool, are 
very great ; and at first, of illy digested food, of a pale color, 
without any mixture of bile. Soon, however, they become 
bilious ; great heat is felt in the stomach, and sometimes the 
throat and mouth seem excoriated with acid. The discharges 
become darker as the disease progresses. Great thirst, ten- 
derness of the abdomen, flatulence and some fever, seem to 
announce the inflamed state of the stomach and intestines. 
But these symptoms readilv give way, and it is doubtful 
whether a state of inflammation really exists. In a few cases, 
I have seen the discharges copious and fluid, resembling rice 
water, and, in these cases, the spasms were destressing, and 
the danger sjeat. 

It is not always easy to discriminate a cholera morbus, from 
other diseases attended with vomiting and purging. Dysentery 
is frequently, at first, attended with these syrnptoms. The 
pain is, I think, lower down in the intestines ; and there is less 



364 CHOLERA MORBUS. 

spasm or cramp than in cholera. A paroxysm of bilious fe- 
ver, is often very simjlar to an attack of cholera ; and is not 
easily discriminated from it, on the first day. I think it is al- 
ways attended with more fever, and less spasm ; and its re- 
turn at the next paroxj^sm, removes every doubt. Certain 
poisons, especially arsenic corrosive sublimate, and the salts 
of copper, produce symptoms very like those we have been 
describing. 

It is of special importance to know the symptoms produced 
by arsenic, because we have a remedy to arrest it. I think it 
should be suspected, in cases attended with greater pain, and 
burning in the stomach, incessant vomiting, and discharges 
soon becoming bloody. 

For the same reason, it is very desirable to know the effect 
of corrosive sublimate. This article, when taken, is apt to 
produce its peculiar horrid burning at the stomach, and inces- 
sant vomiting immediately after it is swallowed. Its detection 
is the easier where it is taken by mistake for some other medi- 
cine, and not concealed in some article of food, as arsenic 
when corruptly used is apt to be. 

The salts of copper, for which we are not in possession of 
any proper antidote, produce symptoms still more resembling 
cholera. The sulphate I believe is so suddenly emetic, that 
it has seldom proved dangerous when taken by accident. Its 
discharge from the stomach is so sudden, that the mischief it 
might cause, is averted. The carbonate of copper — verdigris, 
is a more dangerous article. I have heard of its causing 
death, from eating food carelessly prepared in copper vessels. 
I once knew many persons poisoned by eating, at an enter- 
tainment, syllabub thus prepared. Many of these cases were 
very alarming, and some of the subjects seemed to escape 
death very narrowly. The vomiting did not occur in much 
less than half an hour. It then came on suddenly, and was 
so incessant that it was almost impossible to administer any 
remedy. Water, or tea was instantly rejected ; and the vom- 
iting, in some cases, w T ent on till blood, in considerable, quan- 
tity, was discharged. It did not operate much as a purga- 
tive. 

TREATMENT OF COMMON CHOLERA MORBUS. 

The first effect of cholera, is to produce vomiting and purg- 
ing, to the thorough evacuation of the contents of the stomach 
and bow r els. If this salutary operation is not sufficiently co- 
pious, draughts of warm water, or weak tea should be given. 



CHOLERA MORBUS. 365 

If these are rejected, and the nausea and vomiting continue, 
an emetic of ipecac has been recommended. I do not, how- 
ever, use the emetic, having, as I think, uniformly found opium, 
with or without calomel, a better remedy. I give from one to four 
grains, according to the violence of the disease. If the vom- 
iting continues, or after being for a time suspended, returns, I 
repeat the remedy in less doses. Thus with opium alone, I 
have cured hundreds of cases of cholera morbus ; having ad- 
ministered it without any further precaution, than satisfying 
myself that by the operations of nature, a thorough evacua- 
tion of the stomach and intestines, had taken place. This is 
still my practice, where the patient has been enjoying ordinary 
health, and I have no reason to think he has dyspepsia, inflam- 
mation of the liver, or other local disease of the viscera of the 
abdomen. But if 1 find fever supervene, with more or less 
tenderness of any portion of the abdomen, I lose no time in 
giving calomel. In cases of much violence, I advise this reme- 
dy, combined with opium at first. Ten grains of calomel, 
with three of opium, is an efficient remedy. If the case does 
not give way at once, I regard the calomel as the only proper 
remedy. It is to be repeated, if necessary, in smaller doses, 
till easy bilious discharges are brought on, and relief is nearly 
certain. Some care may be necessary to avoid a salivation ; 
by interposing a dose of castor oil, if the calomel is continued 
more than two days. But the probabilities are so strong against 
a salivation in this disease, from all the calomel it will be ne- 
cessary to give, that I hardly deem it necessary to give the 
admonition. 

With what has been said of the use of opium, calomel, and 
castor oil, I might safely leave the subject of cholera in grown 
persons. There are, however, minor ills, and minor remedies, 
in this disease. The acid, sometimes so painful on the stom- 
ach, may require prepared chalk or lime water to correct it. 
I object to magnesia in this case, because its cathartic tenden- 
cy is to produce the watery discharges, so prostrating in chol- 
era. Sinapisms, or blisters, over the pit of the stomach, may 
be useful in obstinate cases, and should be tried in their turn. 
Where the case has been badly treated, or there is a previous 
diseased state of the viscera, the patient frequently remains fe- 
verish. Remedies aie seldom necessary in these cases; a lit- 
tle time and rest are all that 1 have found necessary. 



366 CHOLERA IN INFANTS. 



CHOLERA IN INFANTS— CHOLERA INFANTUM. 

In teething children, cholera is so different from the same 
disease in grown persons, that it requires a separate considera- 
tion. It is a disease of summer, differing, in most cases, as I 
think, very widely from the attacks of vomiting and purging 
sometimes occurring in cold weather, from excess in eating. 
But in infants, it becomes a general disease of the system ; fre- 
quently protracted through the whole summer, producing in 
the time, many paroxysms, with fever, and wide spread or- 
ganic derangement. It is, in some parts of the country, known 
by the term " summer complaint ;" and, independent of the 
danger attending it, may well be regarded as the scourge of 
the nursery. So little notice is taken of this disease by for- 
eign writers, that we are warranted in the belief, that its for- 
midable character is to be inferred, only from the experience of 
the people of the United States. Here its dominion is univer- 
sal ; and although a disease of summer, it prevails from New 
Orleans to Boston — from New York to St. Louis. Nor is it 
sensibly worse in warmer latitudes ; for it is still doubtful, 
whether it is most to be feared in New Orleans or in New 
York. It was long regarded as the plague of cities ; but it is 
now conceded, that no locality is a refuge from its attacks ; 
and it has appeared in the circle of my practice, as often in 
the best and most comfortable summer residences, as in the 
worst. 

CAUSES. 

Why cholera infantum should be in the United States, a for- 
midable disease, and in the rest of the world, comparatively 
harmless, will probably be forever unknown. It seems idle to 
attribute to teething and hot weather, effects in this country 
which they do not produce in others. I concede, then, that 
there is some unknown cause of cholera in this country, which 
exerts its powers on teething children in summer. I have not 
found it worse in moist, than in dry weather ; or in very hot, 
than in moderately warm summers. But 1 have always seen 
it arise, and extend, with the warmth of summer ; and, in 
some years, become so general, and fatal, as to force on the 
mind the conviction, that there existed for it some general 
cause. Nor is its appearance in hot weather, more marked 
than its disappearance when the weather becomes cool. Sev- 



CHOLERA IX INFANTS. 367 

eral times it has happened, in my practice, that the cases of 
the season had been inveterate, and several children seemed to 
hold on to life as if to wait for some expected relief. This re- 
lief has been found, in a sudden change to cold, which, in eve- 
ry case, has produced, in a single day, a change so radical, as 
to give perfect assurance of recovery. We are then fully au- 
thorised, to set down the heat of summer, as one of the causes 
of cholera in infants. 

Teething is another cause, which I have found to influence 
the course of the disease, more than warm weather. True, it re 
quires both to produce and continue the disease; but I have never 
seen a well marked case of cholera infantum, except duing the 
period of cutting teeth in children, from four or five months, to 
three years of age. But the influence of teething on a case 
which has already occured, is remarkable. Every pair of 
tteth, or every single tooth, when they do not appear in pairs, 
as its growth progresses from the jaw through the gums, seems 
to produce its paroxysm of the disease ; and when the eye 
teeth, and first jaw teeth are obtained, and fully grown, no 
heat of summer can protract the disease. A diarrhoea may 
remain, but the symptoms are entirely changed. 

Bad food must also be regarded as a cause of cholera in in- 
fants. I have no idea that this alone would produce any thing 
more than a diarrhoea; but I have often seen paroxysms of chol- 
era seem to be brought on by improper food; and nothing is more 
injurious in this disease, than the milk of an unhealthy nurse. 
Yet it is not every sickly mother who gives unwholesome milk ; 
and some attention is necessary to detect the cause, when it 
depends on the food drawn from this source. 

SYMPTOMS. 

Some fever and diarrhoea may be expected to occur in a 
teething child, in summer or winter. It is only when it be- 
comes inveterate, that a remedy is required. But the attack 
of cholera, although attended with free discharges from the 
bowels, is a very different affair. Yet the difference is more in 
degree than in kind. The attack of cholera is sudden and vio- 
lent — commonly in the night, but frequently in the day time. 
Fever from teething, has probably existed for several days ; 
but a chilliness, with pale face, dreadful nausea, frequent vom- 
iting, with copious discharges by the bowels, are always pres- 
ent at the first attack. The child, prostrate in its nurses arms, 
lies inattentive to surrounding objects — its chief pain is thirst, 



368 CHOLERA IN INFANTS. 

it opens its eyes to demand water ; and on receiving it, sinks 
again -to an apparent slumber, to be aroused in a few moments 
by vomiting. Young children, impelled I have no doubt by 
thirst, draw eagerly at the mother's breast, to experience the 
same fate — a few minutes' rest followed by vomiting. Spasm 
of the limbs, or pain in the bowels, seldom occurs, during these 
paroxysms. The attack, like the paroxysm of a fever, runs 
its course in a given time — a few hours, or at most a day. 
Prostration attends it from the first, and 1 have seen death oc- 
cur in twenty-four hours ; but this is very rare, and it may be 
reckoned on with some confidence, that the storm will blow 
over, and the little sufferer rise the next day, bright and play- 
ful it may be, but shorn of its strength, and greatly reduced in 
flesh. Appearances are now very fair — a pair of teeth per- 
haps appear, and weeks pass before we are again called to 
witness a renewal of the same symptoms. On examination, 
it will be found, that another pair of teeth are about to appear ; 
and the child is fortunate if it escapes with but one attack for 
each pair of teeth. More frequently, the attacks are at the 
rising of the teeth from the process of the jaw bone, and again 
on their reaching the top of the gums. Where a single tooth 
appears at a time, the attacks are multiplied, and the case a 
great deal worse. In some cases, the attack returns no more, 
and a cure as in grown persons, is effected by bringing the first 
paroxysm to a close. These fortunate cases I have thought oc- 
curred, principally in children whose teething, having com- 
menced the previous year, was nearly accomplished at the 
time of the attack; but the child which, in May or June while 
cutting its first teeth, has an attack of cholera, will seldom fail 
to have it again and again, during the summer. 

The disease has now but begun its career. Whether the at- 
tacks regard the progress of dentition, as I have supposed, or 
are governed by things seen or unseen, they are renewed, from 
time to time, at uncertain intervals. The paroxysms, if less 
violent are more protracted ; and the fever, in some cases, 
seems to continue nearly all the time. Others, however, run 
out of every attack with a cool clammy surface ; and no ob- 
vious fever. In every case, the flesh gives way, and the skin 
has a peculiar flabby and folded appearance, as if its power of 
contracting to the dimensions of the body, were lost. The re- 
turn of the disease by paroxysms, in most cases, continues to 
the end ; and, in these cases, the recovery is most perfect. In 
many cases, the disease having several times occurred in pa- 
roxysms, becomes at last continued. A low fever and diar- 



CHOLERA IN JXFANTS. 3G9 

rhoea attend it, sometimes with frequent and painful discharges; 
and in other cases, equally wasting, but copious and not frequent 
evacuations. Food, or milk from the mother, is no longer di- 
gested — aphthae (yellow thrush) is seen on the tongue, or in- 
side of the lips. Great irritation is manifest in the stomach, 
and bowels— the discharges are acid, and excoriate the anus, 
and the adjoining parts — the countenance changes, the eyes 
become blood-shotten, and the brain being attacked, stupor 
and death close the scene. It would be useless, if I could re- 
member them, to point out every symptom which will present 
itself. I have mentioned those I have most frequently seen, 
and I think enough to identify the disease. 

Death seldom occurs, till the patient is exhausted, and re- 
duced almost to a skeleton. Nor does it then always arise 
from mere waste of the body. Examinations after death show 
fatal alterations of the vital organs, such as the stomach, the 
intestines, and the brain ; but the liver, in which we might 
readily suspect the greatest changes seems to be least affected. 

Recoveries happen in cases apparently the most unpromis- 
ing. The degree of waste and exhaustion of the system, can 
hardly be so great as to preclude the hope of recovery ; and I 
have seen patients rise, after having almost every symptom re- 
garded as most fatal. Within a year past, my mind reverts to 
two cases, in one of which a squinting, not a cross eye, and a 
heavy head, pitching down on the pillow, and refusing to be 
held in an erect position, seemed to point out a fatal disorder 
of the brain ; and in the other, a vomiting of blood at every 
attack, till it seemed almost impossible that a single repetition 
of the hemorrhage could be borne, while other symptoms were 
very unfavorable. Yet these patients both recovered per- 
fectly. 

TREATMENT. 

The remedies for cholera in infants, are the same as those 
for grown persons ; but they should be varied according to the 
circumstances of each particular case. The vomiting and 
purging of a moderate attack, cannot be regarded as unfavora- 
ble circumstances. They are salutary, and ought not to be 
checked unless they go too far. If the nausea is great, and 
the efforts to vomit raise nothing from the stomach, give from 
three to five grains of ipecac in water. This will commonly 
effect the free discharge of the contents of the stomach. Te- 
pid drinks may be offered; but if they are refused, give cold 
water in small quantities at a time. This is by far the best of 
24 



370 CHOLERA IN INFANTS. 

all drinks for a child in sickness, as well as in health. As soon 
as the contents of the stomach seem to be evacuated, give a 
full dose of laudanum, say five drops to a child a year old; 
and repeat it if it is thrown up, or after an hour or two, seems 
to have failed to control the vomiting and purging. 

If the disease is not fully arrested by this means, and it has 
not been done, lose no time in giving calomel. It may be giv- 
en at first, or after the laudanum has in some degree quieted 
the stomach. It may be given alone in doses of a grain, once 
in three or four hours, or combined with chalk as follows : 
Take of calomel four grains, prepared chalk twenty grains ; 
rub well together, and divide into four powders, one to be giv- 
en in syrup every four hours. If two or three free billious 
passages are brought on by the next day, give nothing else ; 
but if not, give a tea spoonful of castor oil, and repeat it after 
two or three hours, if necessary. This will properly close the 
treatment of the paroxysm. 

Another attack may be expected in a short time. This is 
to be treated in the same way, recollecting the weakness, 
which will now be greater than before. More fever may 
now be expected, and laudanum should be given with more 
caution. The calomel and chalk are now the more necessar}^ 
and should a diarrhoea supervene, two grains of Dover's pow- 
der may be given, at night, or evening and morning, if neces- 
sary. 

The intervals between the paroxysms commonly become 
less perfect, and a diarrhoea is almost constantly present. The 
stomach also becomes more seriously disordered, acid eructa- 
tions, inflamed gums, and thrush, or aphthous sores appear on 
the tongue, or inside of the lips and cheeks. This state of 
things is best met by a dose of calomel of about three grains. 
It may be expected greatly to relieve the fever, and to cause 
the ulcers in the mouth to heal in a short time. If the dis- 
charges of the bowels continue large and frequent, from three 
to five drops of laudanum may be given at bed time, and again 
after twelve hours, if necessary. Various vegetable astrin- 
gents have been given to suppress the diarrhoea, which so of- 
ten attends this disease ; but they have seldom answered my 
expectations. I may, however, mention the first and best ; 
the decoction of oak bark, in doses of one or two tea spoonsful, 
according to its strength. Tincture of rhubarb, in doses often 
drops or less — tincture of kino in the same dose, and many 
others ; but I will repeat it, they are but little to be relied on, 
in this disease. 



CHOLERA IN INFANTS. 371 

If the case proves obstinate, and the strength of the patient 
gives way, a small portion of brandy, about a tea spoonful 
with sugar and water, may be administered, once or twice a 
day. The acidity of the stomach may be combated by chalk 
julep, made by rubbing prepared chalk into a thick mucilage 
of gum Arabic, and adding a little essence of cinnamon or lav- 
ender. The dose given should contain about five grains o 
chalk, and be repeated three or four times a day. But a much 
more simple, and I think in most cases, a better mode of ad- 
ministering chalk, is to rub it up very finely, and put forty 
grains of it in a vial, with two ounces of water. Shake this 
when it is to be given, and give it in doses of a tea spoonful. 
It has the great advantage of not turning sour, or running into 
any fermentation, and may therefore be safely kept for use, for 
any length of time. Lime water, a solution of potash, in the 
common form of salaratus, and carbonate of soda, are remedies 
in the hands of every one, for the removal of acid. The dose 
is uncertain, for it should correspond with the quantity of acid 
present in the stomach. The dose of salaeratus and of carbon- 
ate of soda, may range from three to six grains. Lime water 
may be given, a tea spoonful at a dose, in water or in milk. 

The remedies in this disease are to be varied with its vio- 
lence. Suddenly in some cases, symptoms of prostration oc- 
cur — the discharges by vomiting nearly cease, but neither the 
stomach nor bowels will retain any thing. A substance is no 
sooner swallowed than it is rejected ; and if a very small 
amount of very thin bile is passed by the bowels, it is with 
straining and pain. The thirst is intolerable, and the counte- 
nance, haggard and distressed, is expressive of the deepest 
agony. Laudanum is, in this case, the great reliance — five 
drops to a child a year old, repeated according to circumstan- 
ces. The same symptoms sometimes occur in cases of long 
standing. They in these cases betoken more danger, but re- 
quire the same remedies. The relief from laudanum is some- 
times signal ; but in some cases, it is rejected instantly from 
the stomach, and not much better retained if administered as 
an injection. It should not be too far persisted in. Hope is 
now almost extinct — the patient's anxiety for water is such, 
that it will swallow the most offensive fluid — its haggard eyes, 
constant moving, and violent contortion, cannot be described. 
I have not seen sinapisms to the limbs, or over the pit of the 
stomach avail any thing in these cases. But I have often seen, 
the simplest, and most grateful of all remedies succeed. Yes, 
where all the milder stimulants, and even laudanum have fail- 



372 CHOLERA IN INFANTS. 

ed, I have seen the judicious administration of cold water, re- 
lieve like a charm. I cannot recount the times in which I have 
entered the rooms of these little sufferers, under circumstances 
more desperate than I have described. I have taken in one 
hand a tumbler of water, and in the other a tea spoon, and ad- 
ministered a very few drops at a time. The child instantly 
becomes still, looking eagerly for its next dose, of which it 
should not be disappointed long enough to make it restless. 
The process should be continued with short intervals, till the 
child refuses to drink any more. If it throws it up at first, let 
it be repeated. But, with due deliberation, the water will sel- 
dom be rejected. The stomach should be allowed time to ac- 
custom itself to its presence. I have often seen the child which 
would have swallowed greedily, half a pint of water every five 
minutes, and have thrown it up as soon as swallowed, become 
satisfied with less than half a pint, slowly administered with a 
tea spoon. The relief thus obtained, is as radical as by other 
remedies. A gentle slumber commonly comes on, and con- 
tinues for an hour or more ; and very often this proves the end 
of the paroxysm. I have, in many instances, found it unneces- 
sary to administer any other remedy, and have dismissed my 
patient with only the proper directions in relation to its food 
and drink. 

I have dwelt longer on this disease, than might appear neces- 
sary ; but not longer than its importance, in the country in which 
I have practiced, will justify. It is a fruitful source of death to 
teething children ; and where the child is from any cause de- 
prived of the advantage of wholesome nourishment from its 
mother, or a wet nurse, its chance of life is dreadfully lessened. 
-The lingering character of the complaint, renders it all impor- 
tant that its treatment should be familiar to nurses and mothers, 
and I shall not think the subject disposed of till I have reca- 
pitulated its remedies, and added some rules for regulating the 
diet and drink, in the whole course of the treatment. 

RECAPITULATION OF REMEDIES. 

The doses mentioned, being for a child one year old. 

1. In the first part of the attack, give nothing till, by repeat- 
ed discharges, the stomach and bowels are fully evacuated. 

2. If the child rejects warm water, or refuses it in such 
draughts as to cause a very free discharge from the stomach, 
give cold water, in small quantities. Its thirst should be at 
least partially relieved. 



CHOLERA IN INFANTS. 373 

3. Give, after the free discharges above spoken of, a dose of 
laudanum — five drops, or a little more, if the patient is in the 
habit of taking this remedy. What shall I say to physicians 
who, governed by high authority, refuse to use opium in de- 
cided doses, at long intervals ? Shall I tell them that I have 
tried it a thousand times ; and, that instead of a resulting irri- 
tability of the stomach, and increase of fever, I find the reverse 
in every particular? Shall 1 say, that whereas when I was a 
young practitioner, shunning calomel and opium, as injurious 
or dangerous, except in such small quantities as to be useless, 
I was far, very far less successful in the treatment of this dis- 
ease, than lam now? 

4. After twelve hours, or earlier, give calomel or calomel 
and chalk, as follows : take of calomel four grains, prepared 
chalk, twenty grains ; divide into ibur powders, and give one 
every four hours, till free bilious discharges are brought on. If 
no operation is seen in twelve hours, give a tea spoonful of cas- 
tor oil, or some other mild cathartic. 

5. This disease has intervals, not requiring during their con- 
tinuance any remedy. But on a return of the vomiting and its 
attendant symptoms, repeat the same remedies, avoiding too 
much laudanum, and continuing the calomel and chalk, for a 
longer time. 

6. The diarrhoea and aphtha?, or thrush, require a full dose 
of calomel ; say three grains, followed by a tea spoonful of 
brandy, from time to time, with laudanum according to cir- 
cumstances. Vegetable astringents, decoction of oak bark, if 
made strong, a tea spoonful two or three times a day — tincture 
of rhubarb, eight or ten drops, &c. 

7. Alkalies and absorbents to correct acid on the stomach. 
Prepared chalk is the best, and is to be given in doses of five 
grains, repeated if necessary. Lime water, a tea spoonful — 
salasratus, and carbonate of soda, in doses of from three to six 
grains. 

8. The alarming and violent states, in long standing cases, 
require laudanum. When the thirst is intolerable, give five 
drops, repeated three or four times a day, if necessary. At 
any tune when thirst becomes insatiable, and the stomach 
rejects whatever is taken, give cold water in minute portions, 
carefully avoiding to give more than the stomach will retain. 

I have a remark to make here. Calomel, especially calo- 
mel and chalk, furnish our great reliance in the treatment of 
cholera in infants. It is to be used alone, or with opium, ac- 
cording to circumstances. It may be given in the paroxysm, 



374 CHOLERA IN INFANTS. 

or in the interval, and when it produces its peculiar effect on 
the liver, causing the discharge of thick bile, the patient will 
almost always find relief. It is not, however, to be continued 
during the whole treatment of obstinate cases. After three or 
four grains are given, it is to be suspended for some days, un- 
less it has been followed by cathartics of other kinds. 

9. When the disease has continued for a great length of 
time, producing diarrhoea and aphthae, or thrush, either in the 
mouth or around the anus, there are besides the general reme- 
dies recommended above, certain local applications to be 
made. Lunar caustic is by far the best. A strong solution, 
or what is better, the direct application of the caustic to the 
ulcers, is not to be neglected. The pain given is but momen- 
tary, but the relief is very great. Alum may be used in the 
same way, and any vegetable astringent may also be used. 

The frequent recurrence, and lingering character of this dis- 
ease, make it important that the proper diet and drink should 
be used. Milk from the mother, or a healthy nurse, is by far 
the best, and supplies in itself, all the food, and nearly all the 
drink, which should be allowed. It should be taken, how- 
ever, not to satisfy thirst, but hunger. A little attention will 
enable us to judge, if the child has more thirst than hunger; 
and if it has, let it have water before it is allowed the breast. 
It will, in this way, be restricted to the food it requires. 

Water is to be allowed, rather in proportion to the fever, 
than the thirst. It is to be given cold, and in small quantities, 
frequently repeated. Water is nature's great remedy for thirst ; 
and its qualities are not improved by the thousand additions 
made to it by man. I reject without hesitation, all oily or mu- 
cilaginous drinks, such as flax-seed, or other tea, mucilage of 
gum Arabic, bene leaves, or a hundred other equally worthless 
remedies, which have been used under the belief that they 
were better than water. 

There are many cases in which other food than that furnish- 
ed at the mother's breast, is necessary. This may arise from 
ill health of the mother, or a failure of a supply from that 
source ; or it may arise from the diseased state of the mouth, 
hindering the child from sucking. In any event, let good heal- 
thy milk from the female breast, be procured, if possible. I 
have often seen a change to a healthy nurse produce instant 
relief. In some cases, the milk is so bad, as to be instantly re- 
jected, when other food, or other milk will be digested. From 
whatever cause it may become necessary, to give food differ- 
ent from that which the mother supplies, it should be given 



CHOLERA IN INFANTS. 



375 



with the important precaution, not to allow fluid aliment to 
supply the place of water. A child, in this disease, is never 
too young to drink water. But the food, from necessity, must 
be to some extent fluid. Milk should be first tried. It may 
be used raw or boiled ; and I have found but little difference 
in favor of boiling. A little milk and sugar put into boiling 
water, is as grateful, and as safe, as any thing T have tried. Its 
nutritive qualities may be governed by the quantity of milk 
and sugar, used to a given quantity of water ; and I have found 
it for preferable to tea or coffee, even to older children, as food. 
It should not be given too warm. 

In protracted cases, the appetite becomes ravenous, and 
richer food becomes necessary to supply the exhausted solids. 
Starch, in various forms, is the first article to be mentioned. 
It should be such only as has been prepared for food, in the 
form of arrow root, sago, tapioca, &c. These are to be pre- 
pared by boiling, and require to be made fully done. Sugar, 
spices, and wine, may be added to give an agreeable flavor ; 
but they are not to be used in too great quantity. A little salt 
is all that is necessary. Bread, if stale, or unleavened, as 
crackers or soda biscuit, may be reduced by boiling to a proper 
consistence, and used in the same way with the preparations 
of starch. 

Rice is a superior article of food in these cases. It requires 
only boiling, and should be eaten as dry as the patient will 
take it. It admits of the addition of milk or butter, as the case 
may indicate. 

Corn meal is more oily, and less digestible, than wheat flour. 
It is less agreeable to such patients ; but in the form of small 
hominy or mush, it is often a very good article. 

Various farinaceous roots may be tried — the potatoe first, 
and best ; but the sweet potatoe, although an indigestible ar- 
ticle, may be tried, and will be sometimes found to answer 
very well. 

Salt, which has been regarded with no particular favor in this 
complaint, is, in my opinion, often a valuable remedy. It 
should be freely given in food which admits it. 

Sugar, and the bread containing it, are indigestible and bad ; 
and fruits, and melons, equally so. But these articles are 
much craved by children ; and at the time in which there is no 
fever present, they are less hurtful than might be expected. 
Indeed I have no doubt that the}' are at times beneficial ; the 
juice of the sugar cane, and of hard apples, which yield a trans- 



376 CHOLERA IN INFANTS, 

parent juice, I have seen decidedly so, when taken in modera- 
tion. 

No article of food or drink should be persisted in, when it 
has become loathsome to the patient. Variety in food is ne- 
cessary, and it is not always certain that the opinion of the phy- 
sician is a surer guide, than the indications of appetite. In no 
disease is caution, and a close observation of the effect of 
remedies, more necessary — in none do we so often see the ig- 
norant nurse occupy the place requiring the talents and expe- 
rience of the physician. 

These remarks ought not to be closed without a few words 
on animal food. I have said that milk from the mother's 
breast, is the best of all food for children with cholera. Next 
to that, the milk of cows, or, what I have no doubt would be 
better, of goats. Next to these, my preference has been given 
to bread stuffs, farinaceous roots, and some fruits of the sea- 
son. I now place, the flesh of animals at the foot of the list ; 
not that it is to be rejected, throughout the treatment of this 
tedious malady ; but because in its most violent stages, when 
nature is throwing off her substance, and fever and loathing of 
food forbidding the thought of meat ; it would be hurtful or re- 
jected. But in the absence of fever, or in a state of great ex- 
haustion, even when the fever is not entirely off, we may cer- 
tainly look to meat, the most nutritious of all food, to supply 
the waste of nature. The flesh of chickens, or smaller birds, 
is allowable first — next lamb or venison — then pork, bacon, or 
beef. If diarrhoea is present, beware of soups, or fresh pro- 
visions. They are often swallowed greedily, and yet operate 
as a cathartic. Yet there comes a time in which they may, 
by the help of plenty of salt, be digested. When they are first 
tried, let their effect be closely watched. Beef and pork, well 
cured, are the most nutritious, but the most stimulating. They 
are exceedingly grateful to children when convalescent. They 
are digested even by the most feeble, the powers of the stom- 
ach seeming to rise with the demands of the system. Give 
the little sufferers a piece of ham, or beef in their own hands. 
Let them chisel it off with their front teeth, and if they have 
no others, let them swallow it whole. Take care that this is 
allowed only to those who are free from fever ; be careful not 
to give them too much, and carefully notice its effects before 
giving any more. I recall with pleasure the memory of many 
cases, in which I have seen, the most emaciated little children 
thus tugging at their piece of ham, and greedily supplying two 
Great wants of nature, salt and food. Sometimes finding it too 



EPIDEMIC CHOLERA. 377 

stimulating, I have had to forbid the use of such a luxury — of- 
tener by far I have found it agree perfectly well with them ; 
but never did I witness a relapse into a parox3'sm of cholera 
from this cause. 



EPIDEMIC CHOLERA. 

From the time of Sydenham, cholera morbus has been re- 
garded as a disease, which sometimes appears so generally 
over large tracts of country, as to deserve the character of an 
epidemic. In our times another, and, I have no doubt, a dif- 
ferent disease, with nearly the same symptoms, has spread far 
and wide in the most densely peopled parts of the world, and 
produced a mortality, which may compare with the most fatal 
plagues of history. This disease has received the name of 
epidemic cholera ; and although very much resembling chole- 
ra morbus, in its symptoms and treatment, is, in its worst forms, 
so different, and indeed so awful, that it has attracted the great- 
est attention from the most enlightened medical men of the 

a s e - 

The cities of Jessore and Calcutta, in India, are claimed as 
the first parts of the earth on which this fearful disease made 
its appearance. It occurrred in August 1S17 ; and it is uncer- 
tain whether it was ever before seen. But the investigations 
of history which have been made in reference to it, leave little 
doubt that it has been described by historians as a plague, the 
general term for pestilential diseases used by the writers of the 
age of the decline and fall of the Roman Empire. 

Its progress since its commencement in 1817, has been fitful 
and irregular ; but it had, in about twenty years, visited al- 
most every city of any note on the face of the earth. Through 
India its progress was so rapid, that in a few months its visit 
had been paid to every department of that great peninsula ; 
but in Europe and in North America, its progress was com- 
paratively slow. Nor were its movements directed by any 
particular lines ; sometimes seeming to vault over certain na- 
tions to break out in others more distant ; but after a consid- 
erable time, sometimes years, to make its appearance in the 
districts apparently before neglected. Nor has its continuance 
at any particular place, been more uniform — sometimes its 
work of death being accomplished in a few days, it would dis- 
appear from a city, while in others, it would remain for many 



378 EPIDEMIC CHOLERA. 

weeks or months. In Calcutta, it has hardly failed to appear 
every year since 1817 ; and now in the winter of 1846, it is 
said to be raging in certain districts of Persia and Russia. 
Canada, the United States, and Mexico were attacked in the 
summer of 1S32. It has not, as far as I know, been seen in 
North America since 1836. 

Whether this disease is infectious, or arises from some hid- 
den cause unconnected with the intercourse of men, is not a 
question of mere curiosity. If by any care in avoiding inter- 
course with the diseased, the spread of this formidable mala- 
dy can be avoided, the best way of accomplishing this is sure- 
ly a matter of interest. But if the disease is not infectious, 
and not increased by the commercial, military, or social inter- 
course of men, the benefits of the sick, and the comfort and 
well doing of those who are so fortunate as to escape, will be 
greatly promoted by this fact being well established and fully 
believed. It is much to be regretted, that a matter of such im- 
portance should be still undecided. Opinions are divided ; 
and I who have never seen the disease, will not offer an opin- 
ion of my own. 

The facts which have been reported from reliable sources, 
give on this question arguments on both sides. The epidemic 
cholera which we are considering, was first brought to our no- 
tice in India, in 18.17 — its spread over that thickly peopled 
country was rapid, and China soon felt its effects. Its route to 
Europe, seemed to be through the higher latitudes of Asia, 
through Russia and Persia, along the shores of the Caspian 
sea to Poland, to England, to France, and thence South and 
East to Africa, and probably to Arabia. Soon it made its ap- 
pearance in North America at Quebec, and at Mexico, nearly 
at the same time. The believers in infection explain all this 
in a way very natural. Commerce, they say, in a country 
peopled as densely as India, wiU of course give to such con- 
tagion, its readiest means of propagation. Hence its first ap- 
pearance in great cities, and the certainty of its appearance on 
every line of great commercial intercourse. Its contagion, 
they admit, is weak, allowing multitudes exposed to it to pass 
unhurt ; but this the more readily accounts for its rare appear- 
ance in thinly peopled countries. They admit that the inter- 
course of individuals seldom gives any evidence of one having 
contracted it from another ; but the array of facts showing that 
the arrival of ships, persons, and goods, or armies, from in- 
fected places, and the sudden appearance of cholera, have 
so often been witnessed., that it seems impossible to doubt 



EPIDEMIC CHOLERA. 379 

the fact of the disease being transported by these means. 
At the time it made its appearance in Europe, I well recol- 
lect the uncontradicted statement of its being brought to Po- 
land by the Russian army ; and the surprise I felt at the 
cholera, with which I had always associated the idea of hot 
weather, laying waste an army encamped on ground covered 
with snow. The same idea prevailed with regard to its arri- 
val in this country ; and it was stated, that the crew of the ship 
which brought it to Quebec, were attacked before the citizens 
of that city. And I believe that it is true, that its course on 
this continent, has been chiefly, or exclusively, along our great 
lines of commerce ; and especially where the rapid movements 
of steamboats rendered intercourse most frequent. There is 
hardly an instance of the appearance of the disease in a thinly 
peopled district, except in an army, or caravan passing through 
it. Nor can I forget the early accounts of the hecatombs of the 
destroyed, which were brought together in India, by mistaken 
notions of religious dutv. The believers in contagion or infec- 
tion, it must be conceded, have strong facts to sustain tneir 
opinions. 

The non-contagionists have also facts as well worthy of con- 
sideration. They point out many instances of the appearance 
of cholera in cities not known to have had any intercourse with 
infected places ; of its passing from a city bevond another, to 
a place, or an arm}', not known to have had any possible 
chance of infection from goods or persons ; of its simultaneous 
appearance in distant places ; of its attacking all parts of a 
city, regardless of the intercouse of its inhabitants ; and, final- 
ly, of the total ineflicacy of quarantine regulations to arrest its 
progress. The question of infection in cholera is yet unset- 
tled ; but I will not close this part of the subject, without a 
single remark of my own. Its field is a crowded population — 
its mortality is greatest amongst the poorest and most misera- 
ble. When a city is attacked, its inhabitants in great numbers 
instinctively leave it, and thus thin out the inhabitants, by 
which means, probably, its course has often been arrested. 
These facts seem to point out the necessit}^ of thinning out an 
infected population. No fear need, in my opinion, be enter- 
tained of spreading the disease by this means. When the ice 
cracks under a company of skaters ; every one's safety is pro- 
moted by scattering — if they huddle together, they all sink ; 
and so it is in cholera. 



380 EPIDEMIC CHOLERA. 



SYMPTOMS. 

General lassitude and debility aie commonly felt for some 
time before the violent attack of cholera. This is attended 
with flatulence and diarrhoea, with pale, or ash colored dis- 
charges. Sometimes they are of a deeper color, and, in a few 
cases, green or bilious. The disorder in this stage seems tri- 
vial, and very often is not revealed to any one ; the patient 
continuing his ordinary pursuits, till the -next stage of the com- 
plaint supervenes. 

Authors have seemed to vie with each other, in the strong 
terms in which the second stage of violent cases of cholera are 
described. No longer mild or tolerable, the symptoms sud- 
denly change, as if the attack were a paroxysm. Vomiting 
and purging, at, or about the same time with, discharges far 
more copious than are ever seen in any other disorder. The 
patient's strength fails him in a moment, cramps seize his mus- 
cles, commonly in the legs first, but soon extending to he ab- 
domen, bowels, anus, and other parts. The spasm is not with 
alternate relaxation, but constant — it is a tonic spasm. The 
discharges, mixed at first with ordinary feces, become in a 
short time thin, sometimes muddy and offensive ; but oftener 
of a whitish color, resembling rice water, or thin starch ; and 
this, more than any other, seems to be considered characteris- 
tic of the disease. Great is the change which happens in the 
countenance and appearance of the patient, in a lew minutes. 
Prostrate and unable to rise, he lies as one suddenly fainting 
from a mortal wound. Pale, or rather blue, his sharp and 
shrunken features are hardly recognised by the most intimate 
acquaintance ; his voice, hoarse and husky, and the smell ari- 
sing from his body, and from his discharges, are altogether 
unlike anything ever witnessed in any other disease. Once 
seen, heard, and smelled, the countenance, the voice, and the 
smell of patients in this fearful disease, are never forgotten. So 
unlike the ordinary attacks of disease, is this sudden attack ; 
and so nearly does it resemble the operation of the most fatal 
poisons, that in Paris, it was at first attributed to poison, thrown 
into wells, or distributed in milk, or other food, by some com- 
bination of malevolent persons. I recollect seeing it stated in 
the newspapers, that many who sold milk in the market, were 
arrested under this charge. This is the more remarkable, 
as the disease had already done its work in Poland. Germany, 
and England. The fact, that under these circumstances, and 
with all that had been said of Asiatic cholera, as it was then 



EPIDEMIC CHOLERA. 3S1 

called, before them, the faculty of Paris did not recognise it 
when it appeared amongst them, may plead loudly in favor of 
those who make mistakes of one disease for another, in ordina- 
ry practice. I do not hold it up as a disgrace to the talented 
individuals who might be obnoxious to it in this case ; but as 
a beacon to warn us all against being too positive in a hastily 
formed opinion. 

In the cases presenting the above described appearances, 
the powers of life speedily give way ; sometimes in a few 
hours, the pulse fails, the heat of the body is gone, and death 
closes the scene. Others linger a day, or longer ; but few 
revive and recover. But it is not always in this terrific form, 
that we are to meet epidemic cholera. In many cases, per- 
haps by the use of proper remedies, the premonitory, or first 
symptoms come on, and gradually pass away without the oc- 
currence of the violent attack. In others, the paroxysm takes 
place with mitigated symptoms ; and the patient, under a 
proper treatment, has a well grounded hope of reaction ; and 
though some fever, a recovery. These mild and medium at- 
tacks resemble the attacks of common cholera morbus, so close- 
ly that the physician who mistakes one for the other, is very 
excusable. I certainly have seen common cholera morbus, 
and dysentery, preceded by a diarrhoea very closely resem- 
bling that described as the harbinger of the disease I am now 
describing. And when the attack of cholera morbus has hap- 
pened, I have seen almost ever}' symptom of spasmodic chole- 
ra which has been mentioned. I have seen the sudden col- 
lapse — the pale and shrunken features, but not the blue com- 
plexion — the feeble, but not the absent pulse — the copious, and 
even the " rice water" discharges — the spasms, tonic and in- 
terminable but in death. These symptoms occur not only in 
epidemic or Asiatic cholera ; but., as I have said, in cholera 
morbus, and as the effect of poisons, especially of fatal doses 
of tartar emetic, or verdigris. 

I have said nothing in regard to the state of the mind in 
cholera. The picture drawn of the disease is truly horrible ; 
and to beholders of the sufferings of the patient, appalling. 
But these things seem to be regarded with indifference by the 
patient — his agony and pain do not disturb the calmness, and 
apparent indifference of his mind. He seems, indeed, less con- 
cerned in the event than any one else. 

From all that has been said, I conclude that the epidemic 
cholera is a disease of the whole system, produced by some 
cause unconnected with atmospheric influences, so far at least, 



3S2 EPIDEMIC CHOLERA. 

as relates to wet and dry, hot and cold : that between the ex- 
posure to the cause, and the appearance of the disease, indefi- 
nite time intervenes; and that, in its own time, it attacks by a 
violent paroxysm : that this paroxysm is, at first, a sinking of 
the powers of life, with the most enormous throwing out of 
fluid from the stomach and bowels, that is ever seen in any 
disease : that, if this shock is withstood, the system rises ; 
and a peculiar fever, which may end in recovery, takes place: 
and finally, that the examinations of the dead render it almost 
certain, that in such as leave the disease to run its natural 
course, there occurs on the internal surface of the intestines, 
an eruption very extensive, but not ending in ulceration. 

TREATMENT. 

The only remedy universally allowed to be of infinite value 
in this disease, is laudanum, or opium in some form. It is giv- 
en in the forming stage, to control the diarrhoea, in d oses of 
from twenty to one hundred drops, repeated occording to cir- 
cumstances. Various aromatics and astringents are given at 
the same time, such as ginger, cinnamon, allspice, and many 
others ; a decoction of galls, or oak bark, or tincture of kino, or 
catechu ; and some have advised the acetate or sugar of lead, 
in doses of a grain or two, repeated often if necessary. Laxa- 
tives, or emetics are regarded as extremely dangerous ; being 
thought liable to precipitate the violent attack. Alcohol is 
thought dangerous, probably because those subject to the in- 
temperate use of it, are often the first victims of cholera. My 
opinion, from all I have learned, is decidedly in favor of lauda- 
num ; but I should not hesitate to combine with it a portion of 
good spirit, if the strength of the patient seemed to be giving 
way ; and this I should prefer to all the astringents and aro- 
matics combined — yet they should not be excluded, if the case 
did not readily give way. Nor could I fear, in this forming 
stage of cholera, to give calomel to the extent of from five to 
ten grains a day — having witnessed its power in controlling 
analagous diseases, I could not doubt it in this, till fairly con- 
vinced by experience. 

The next stage or violent attack of the disease, is treated 
with the same remedies. I recollect to have read the order of 
an army surgeon to the hospital steward of his regiment, to 
have his laudanum and water in a bottle, with a glass, holding 
a dose, I think one hundred drops of laudanum, in readiness, 
so that when one of the men was taken with vomiting, purging 



EPIDEMIC CHOLERA. 383 

or cramp, perhaps of the legs, not a moment's time would be 
lost in administering this powerful remedy. This, I have no 
doubt, was a most judicious order, and calculated to save the 
lives of many, who would, in a short time, have run into a fa- 
tal collapse. The disease, in this stage, is to be commanded 
by opium, or the case is desperate. It has been given with 
scarcely any limit ; and I have known its abuse, in these cases, 
severely censured. I cannot say the extent to which I would 
feel warranted in carrying the use of laudanum, if the spasms 
refused to yield in an hour or two. I should not hesitate to 
give a tea spoonful, hourly, for three or four doses ; and I 
might go much farther, if the symptoms were desperate. Calo- 
mel, in thirty grain doses, has been much used ; and, I think, 
combined with laudanum, is by far the best prescription. I 
should not expect much benefit from the repetition of such 
large doses of calomel. The influence of these remedies on 
the system, are of the first consequence ; and if they are thrown 
up, the laudanum should be given in three times the quan- 
tity, by way of injection, or solid opium passed up into the 
rectum. 

Few diseases have had more remedies recommended for its 
removal, than cholera ; but 1 cannot say I think the loss would 
be great, if they were all lost except opium and calomel. Nor 
should it be concealed, that some who have had experience in 
the use of these remedies, doubt whether they add any thing 
to the safety of patients. They aver that about as many re- 
cover under other, and decidedly inefficient modes of treat- 
ment. This is a sad account of the effect of medicine in this 
disease ; and I am bound to think it erroneous. If opium, and 
a judicious addition of calomel, are not remedies in the highest 
form of cholera morbus, 1 am ready to give over the use of 
remedies altogether. The relief from opium is so sure, and so 
speedy ; and the radical relief from calomel so obvious, that I 
do not for a moment doubt it. Nor do I doubt the vast impor- 
portance of these remedies in epidemic cholera, even in its se- 
verer forms. 

But there are other remedies, which probably ought not to be 
overlooked. In the violent stage, I have no doubt other stimu- 
lants besides opium, are proper. I should try ammonia, cam- 
phor, alcohol, ether, or other similar remedies ; sinapisms, 
blisters, dry heat, warm or hot bathing, and all kindred reme- 
dies, have, I believe, been tried to some purpose. 

Recoveries from cholera are commonly wonderfully rapid. 
But in some cases, a fever supervenes, with more or less dis- 



384 DYSENTERY. 

order of the bowels. The physician is advised, in these cases, 
to pay little regard to the previous states of disease which 
have existed. The symptoms, sometimes, inflammatory, are 
to be treated on general principles, as an inflammatory fever; 
(which see) and, in other cases, symptoms of typhus occur re- 
quiring its proper treatment also. I should think the previous 
exhaustion of the patient, would point out the necessity of 
moderately using depleting remedies ; and that time, in cases 
requiring supporting remedies, should be allowed for their very 
gradual and moderate use. 

Upon the whole, the small amount of reading I have had it 
in my power to do on this subject, and the reflection I have 
felt it my duty to bestow on it, have convinced me that, epi- 
demic cholera is to be treated, in the present state of our 
knowledge, on general principles. No specific, like quinine for 
intermittent, has been discovered for it. Its symptoms are to 
be met with the remedies proper for the same symptoms in 
other complaints ; and, as no disease presents greater variety 
of symptoms, so none admits of a greater variety of remedies. 
The physician should recollect, that he will not, in every case, 
meet the collapse and prostration, so much dreaded in cholera. 
He will sometimes meet a fair pulse, and a warm skin in an 
early stage of the disease. Here he may, without fear, use 
the remedies proper for such a state of the system. Here I 
have no doubt emetics and sedatives, such as ipecac, and an- 
timonial powder, are useful. They have been recommended 
on high authority; but I think sound discretion, and close atten- 
tion necessary in their administration. Where a reaction of a 
somewhat inflammatory type occurs in cholera, I should think 
the danger very small. [ think 1 have observed in the pub- 
lished accounts of cholera, that the cases which occur on its 
first arrival in a city, are almost all fatal ; and that, before it 
ceases, the type so changes, that very few of those who take it 
die. The practice adopted in the outset, is disgraced by its 
want of success ; and that which succeeds it is thought to per- 
form wonders. Probably physicians err in both opinions. 



DYSENTERY. 

Inflammation of the large intestines, is now universally al- 
lowed to be the cause of dysentery. It is true, there are cau- 
ses preceding the inflammation, or ulceration of the intestines, 



DYSENTERY. 385 

some of which we shall notice ; but there is no case in which 
the remark of Doctor Rush, that the proximate cause of a dis- 
ease, is the disease itself, is better exemplified than in inflam- 
mation, as the cause of dysentery. It is always present ; but 
under how many var}*ing circumstances, who can tell ? 

An "unknown peculiarity of the atmosphere," must be al- 
lowed a place amongst the causes of dysentery. It prevails 
as an epidemic, without regard to the season of the year, the 
locality of the place, the food or drink of the subject, or the 
climate of the country it appears in. It is regarded rather as 
a disease of the tropics, because its general prevalence is more 
common in tropical countries ; but hot countries are not alone 
subject to this disease ; for it has often prevailed in almost eve- 
ry part of the United States, and, so far as I know, in all parts 
of the old world. And in every country in which it has pre- 
vailed as an epidemic, it has in turn presented the mildest, or 
the most formidable aspect. It is doubtful whether we are 
ever to understand the nature of the atmospheric influence to 
which the origin of this disease is ascribed. For my own part, 
1 doubt the existence of any such influence in the atmosphere. 
The spread of the disease appears wholly inconsistent with 
the idea of its journeying on the winds. Its range is often 
wide, but still definite. I have several times, when not sus- 
pecting an epidemic dysentery, been consulted on the same 
morning, for patients in various directions, distant twenty miles 
from each other. The disease was already epidemic, for the 
attacks of these patients and many others, were all on the same 
day. Yet it omitted its visits in many places, which the air 
would not have done. The character of the disease differs 
widely in different neighborhoods. 1 have seen it very fatal 
in a neighborhood ; and mild, or trivial a few miles off. It is 
not more apt to prevail, in places subject to the annual visits 
of bilious fever, than in others entirely exempt from it. I have 
seen it epidemic at all seasons of the year, but most frequently 
in autumn. It is as apt to be fatal in winter as in summer ; but 
I have thought its worst features were put on in the fall season. 
I have seen it precede and follow bilious fever, but never to have 
any connexion with it, except what seemed to be accidental. 
The locality presenting the disease in the worst form, has been, 
in my practice, uniformly on alluvial lands ; but on those lands, 
it was as bad, and it has appeared to me worse, on healthy, 
than unhealthy places. This fact I have observed over a coun- 
try thirty miles in extent, not on river bottom, but on elevated 
and healthy pine lands, extending across the State of Georgia 
25 



3S6 DYSENTERY 

immediately below the falls of her great rivers. The primi- 
tive lands immediately above these, have never, to my knowl- 
edge, presented an example of dysentery destroying many 
persons. 

During the existence of the epidemic cause, many cases arise 
from individual pre-disposition, or occasional causes. Many 
are attacked who can assign no reason whatever ; but others 
will be found to have been exposed to vicissitudes of cold and 
heat, wet and dry. Intemperance in eating, and far more cer- 
tainly, intemperance in drinking, will lay the foundation of an 
attack. I have found children more subject to it than grown 
persons ; and have witnessed most deaths from it, in children 
from six to twelve years of age. 

Much has been said of the complication of this disease with 
others. I have never witnessed its complication with any oth- 
er disorder, of the whole system. In those who have local dis- 
orders, of the intestines, liver, bladder, or kidneys, I have found 
it apt to be inveterate, and frequently fatal. All such disor- 
ders, especially those of the liver, are greatly aggravated by 
an attack of this disease. 

Dysentery is a disease of frequent occurrence, independent 
of any general cause. The occasional causes mentioned above 
as causes of it when the disease prevails, are often known to 
produce it at other times. Many persons are subject to fre- 
quent attacks of it, and local diseases are often known to pro- 
duce it. 

When it occurs from occasional causes, and is unconnected 
with local diseases, dysentery is a mere inflammation of the 
great intestines. It will commonly of itself subside, and dis- 
appear, in three or four days. I have known many cases ter- 
minate thus, without the taking of any remedy. Where the 
disease arises from any local disorder, its symptoms and dan- 
ger depend on the character of the cause. Where it arises 
from an epidemic cause, it has a crisis, as well as other diseases. 
I have seen it, at such times, terminate in three days ; but 
it oftener extends to eight or nine, where the treatment has not 
been efficient. I have no doubt that in these cases, a peculiar 
inflammation attacks the colon, and perhaps some portions of 
the intestine above and below it ; and that it does, in its own 
time, produce its peculiar ulceration, or other disorder. That, 
like small-pox or measles, it has a regular healthy termination; 
and that, in mild cases, the ulceration, or other disorder, will 
spontaneously heal. That, like those diseases, the violence of 
dysentery will often produce death ; and, like them, it often 



DYSENTERY. 



387 



leaves, lesion, or ulceration, which may continue for a great 
length of time, destroying the health and undermining the con- 



's 
.stitution 



SYMPTOMS OF DYSENTERY. 



Flatulence and oppression about the stomach, succeeded by 
a diarrhoea, with copious discharges from the bowels, are com- 
monly the first symptoms of an attack of dysentery. Pain in 
the abdomen succeeds, and is attended with violent straining 
at stool, as if there 3-et remained something more to be dis- 
charged. Mucus, or jelly begins to make its appearance in 
the discharges; and, by degrees, becomes the principal mat- 
ter discharged. Blood commonly flows with the mucus ; and, 
in some instances, seems to be distinct — in other cases, the mu- 
cus is stained and bloody ; but in others, where the disease is 
equally severe, there is 'no appearance of blood in the dis- 
charges. As the disease progresses, the torment increases. 
The patient is compelled to go to stool more frequently — often 
hardly reaches bed before he is again compelled to rise — natu- 
ral discharges cease altogether — fever supervenes — the stom- 
ach, disordered in the outset, becomes sick, and the loathing of 
food becomes so great, that the sight or smell of it causes vom- 
iting, or rather straining to vomit. 

These symptoms are too plain to be mistaken ; but there 
are cases in which symptoms of diarrhoea., with free discharges, 
continue all the time — producing alternate passages of mucus, 
and common, or other feces. By degrees the mucous discharges 
cease, and the case terminates as it began, in common diar- 
rhoea. 

The variety in the symptoms of dysentery is still very great. 
In some cases of high grade, the attack is not preceded by 
diarrhoea, but comes on with tormina, and depression, follow- 
ed by fever ; commonly inflammatory, but often typhoid. This 
last form, I have oftenest seen in winter. Dry tongue, tremb- 
ling pulse, incessant discharges of mucus or blood, without 
any natural discharges, announce danger. I have never seen 
it infectious. 

TREATMENT. 

Calomel, or some preparation of mercury, forms the basis 
of ail proper or scientific treatment of dysentery. In com- 
mon, or inflammatory cases, it should be promptly given in full 
doses — from ten to twenty grains. Time must be given for 
its operation — from ten to twelve hours , and, if it has not pro- 



388 DYSEYTERY. 

duced free and natural discharges in that time, give castor oil, 
or some other mild cathartic. Rhubarb, and magnesia have 
been recommended ; and I do not object to that prescription. I 
was once with a detachment of the militia of this State, in which 
there occurred fifty or more cases of dysentery. The medi- 
cine chest was soon exhausted of calomel - 7 and Glauber's- 
salts at length became the only cathartic left. It was given 
without reserve, and not a case of death happened. Lauda- 
num was freely used in these cases. 

Ipecac is the next remedy I should resort to. So much has 
been said for and against this remedy, that I offer my experi- 
ence with hesitation. I give it in full doses to produce vomit- 
ing, in the early stage of the disease ; and, in broken doses, 
say two grains in a pill once in an hour or two, when the case 
has continued for a day or two. It should be persisted in till 
the proper, or bilious discharges, are brought on. Next to calo- 
mel, this is by far the best remedy I have tried for dysentry. 
The sickness of the stomach, and vomiting it produces, are so 
much objected to by patients, that I have, of late, not so fre- 
quently used it. But to those who have a great dislike to calo- 
mel, I commend ipecac. 

Opium comes in next. It should not be given at first, unless 
the pain is intolerable ; but, in that case, give it with the calo- 
mel ; a grain of morphine, three or four grains of opium, or 
eighty to one hundred drops of laudanum, may be given. Its 
great use is in allaying pain ; and, I think, to remove cramp or 
spasm from the bowels. In some cases, when the attack first 
comes on, a full dose of laudanum will put an instant end to 
all the symptoms. 

Bloodletting and leeching have been highly recommended. 
There can be no doubt that bloodletting is a valuable remedy, 
in cases with extensive or violent inflammation. I have seldom, 
however, found it necessary to resort to it; and have observed 
that the most dangerous cases were those which seemed least 
to require it. Leeches, I should also think a valuable remedy, 
where the local inflammation was considerable. But the max- 
im of Brousais that % to apply leeches to the anus, is to an- 
nihilate this disease cannot be maintained with truth. In fact 
this maxim, like others offered in support of a favorite theory, 
is better qualified for harm than good. 

As soon as a thorough and free discharge of the bowels is 
effected, relief is almost always obtained. Even in cases in 
which diarrhoea is present, and there is every appearance of 
excessive discharges, the peculiar cathartic operation of calo- 



DYSENTERY. 3S9 

mel is equally beneficial. But the disease commonly has only 
yielded in a temporary way. In less than a day its course is 
resumed, but commonly in a milder form. The same remedy, 
in quantity proportioned to the circumstances, is now to be re- 
peated. And should it be requisite a third time, or even 
oitener, I should have no hesitation in administering the same 
remedy. 

Some caution should be observed in continuing this course 
of mercurial treatment ; or a salivation may, without necessi- 
ty, be brought on. I have never known this occur, from the 
use of a single dose of calomel, nor from the second dose, if 
due notice is taken, that within twenty-four hours, free dis- 
charges from the bowels are brought on. The third and fourth 
repetitions raise the question, shall a salivation be hazarded ? 
In grown persons, I have no hesitation in using the calomel — in 
children I have more hesitation. Candor requires that I should 
state, that in a case of this disease under my own treatment, 
in a child five years old, a fatal mortification of the jaw oc- 
curred after using two doses, in all, about twelve grains of 
calomel. Both these doses were in due time followed by cas- 
tor oil, and it was reported to me that free and full feculent 
discharges were brought on. This report of the nurse. I had 
afterwards reason to doubt. It is also proper that 1 should 
state, that in this case, the usual symptoms of salivation were 
not present; and that a blue spot on the cheek, which run 
rapidly into mortification was alone present. I may also state, 
that my friend Doctor White, who was called in consultation, 
was of the opinion that this case of mortification, was not the 
effect of the calomel which had been taken. This is the only 
case, in which I have ever thought I had reason to regret the 
use of calomel in d3 7 sentery. I have since used it with more 
Treedom than before ; and have no hesitation in stating, that 
my whole experience warrants the decided preference I have 
given it, over all other remedies in dysentery. 

Under this treatment, this disease will commonly yield in 
three or four days, and seldom continue beyond the ninth. But 
if it continues longer, it begins to be considered chronic, and 
requires a modified treatment. No precise rule can be given 
for deciding a dysentery to be chronic. If the fever attending 
the first stage has given way — the extremities cold, or, at 
times, burning as in hectic fever — the discharges mixed with 
pus, or clear blood unmixed with any thing ; if the pulse is 
small, although sometimes hard — and these symptoms, with 
tormina, tenesmus, and other symptoms of local irritation, con- 



390 DYSENTERY. 

tinue from day to day, with little amendment, the case is to be 
considered chronic. These symptoms denote ulceration, or 
some disorder of great irritation of the lower intestines. In 
its nature it is of course incapable of being suddenly arrested. 
But there is reason to believe, that, in many such cases, the 
ulceration is not unhealthy ; and that it will readily heal. In 
most cases, however, the ulcers prove untractable, the disease 
inveterate, and, in many instances, fatal. 

The remedies recommended in the acute stage, are useful 
in the chronic stage of dysentery. They are, however, to be 
given under rules adapted to the altered circumstances. Calo- 
mel is no longer to be used in heroic doses, and there is high 
authority for discontinuing its use altogether. I am in favor of 
using it, but in small, or alterative doses. From two to four 
grains a day will be sufficient. If the case is complicated 
with diarrhoea, there will be still no objection to the calomel — - 
if the bowels are ulcerated, however extensively, I cannot 
think of making this a reason against this remedy. On the 
contrary, I have seen calomel so often control diarrhoea, and 
remove irritation from the lower bowels, producing the most 
comfortable and least irritating discharges of any remedy I 
have ever used, that I recommend it strongly in chronic dys- 
entery. To what extent it shall be carried, is a question for 
the sound discretion of the practitioner. In general, I should 
avoid producing salivation ; but I should fear no particular ill 
if it should occur. 

Opium alone, or combined with ipecac*, deserves great con- 
fidence in this stage of dysentery. Dover's powder is per- 
haps the best preparation for this purpose, and may be given in 
doses of from five to fifteen grains, twice a day. Laudanum* 
or morphine may be substituted in equivalent doses ; but I ob- 
ject to repeating the remedy oftener than twice a day, and 
should prefer a single efficient dose to the use of it oftener, if 
the quiet and ease it is intended to produce, can be as well 
obtained by a single dose. In every case of dysentery, opium 
used to allay pain, is best administered in efficient doses, at 
long intervals. In this way, it may be safely administered in 
the most inflammatory cases, especially with calomel after 
bloodletting — and where bloodletting is not demanded, it is 
still more safe and useful. For the inordinate and protracted 
distress which commonly attends this disease in its last stage, 
there is certainly no remedy equal to opium. 

The diarrhoea which frequently attends chronic dysentery^ 
is sometimes not relieved by opium ; and astringents of vari- 



DYSENTERY. 391 

ous kinds have been used. The best of these, I have no doubt, 
is sugar of'lead, alone, or combined with opium. From three 
to six grains of sugar of lead, may, in this way, be given daily, 
for many days. I have often used it, and never with any .un- 
pleasant consequence, but often with obvious benefit. Tan- 
nin, the decoction of oak bark, kino, catechu, and many other 
vegetable matters in which tannin abounds, may in their turn, 
be tried. 

Injections have their place in the treatment of dysentery. 
The irritation of the rectum cannot, in my opinion, be benefit- 
ted by enemata, except from, their medical qualities. Opium, 
administered in this way, is often very useful; and sometimes, 
when rejected by the stomach, is used in injections with bene- 
fit. Three times the laudanum that would be required by the 
mouth, maybe used, with a tew ounces of water, in this way. 
A pill of opium of five or six grains, forced into the rectum, 
seems also to answer a valuable purpose. Sugar of lead may 
also be used, in this way. Twenty grains, dissolved in three 
or four ounces of water, combined, if necessary, with opium 
or laudanum, may be given once or twice a day, as an injec- 
tion. 

Cold water, thrown into the bowels as an injection, and fre- 
quently repeated, and also applied over the abdomen with wet 
cloths, has been recommended; and I have no doubt it is, in 
many cases, a beneficial treatment. But I have no belief that 
it can ever be used to the exclusion of calomel, although I think 
there is no danger in using both at the same time. 

But little need be said on the subject of diet and drink, in 
this disease. The patient commonly loathes food, and the 
stomach rejects drink. Neither is necessary or beneficial, in 
the first stage of the disease. But when the case continues for 
many days, a degree of thirst arises, and food is no longer re- 
jected. The food least stimulating, and easiest of digestion, 
is to be preferred. Rice, or arrowroot, is perhaps the best ar- 
ticle ; but others in abundance will readily suggest themselves 
to the mind. 

Water is to be used in preference to every other article of 
drink. Let the quantity taken at any one time, be small, and 
the whole amount taken be not very large ; but avoid the error 
of supposing that a little gum, or a mild aromatic, can make of 
water an improved article of drink. The idea, that demul- 
cent, or mucilaginous drinks, can be brought in contact with 
the inflamed surface of the bowels, is of course childish. In 
the stomach, or small intestines, these matters are taken up, or 



392 DIARRHOEA. 

so altered, as no longer to be the bland and agreeable substan- 
ces they are thought to be. The too free use of them may do 
harm ; but no use of them can afford any benefit, except from 
their nutritive, or stimulating qualities. 






DIARRHCEA. 

Very frequent, or very profuse, thin, or watery discharges 
from the bowels, constitute diarrhoea ; and so mild and harm- 
less is it, in many instances, that it cannot be considered as a 
disease : but these symptoms also attend a state of the system 
so formidable and alarming, and at the same time so insidious, 
that they are to be regarded by all with apprehension. 

I shall, for the sake of perspicuity, divide diarrhoea into, 
acute and chronic, excluding from under this head, the diarrhoea 
which occurs in many diseases, such as typhus fever, or con- 
sumption of the lungs. Nor shall I dwell longer on this divis- 
ion, than to state, that I mean no more by the term acute, than 
a disease of shorter duration, arising from some occasional 
cause ; or by the term chronic, than its longer continuance. 

CAUSES OF ACUTE DIARRHCEA. 

It is true, that the heat of summer, when united with unu- 
sual exposure and fatigue, and sometimes sudden emotions of 
the mind — anxiety — fear, or grief, will bring on those frequent 
and copious discharges from the bowels, known by the term 
diarrhoea ; but these constitute so small a portion of the at- 
tacks of this common disorder, that they hardly deserve notice. 
The great, and almost universal cause of this mild form of di- 
arrhoea, is to be sought for in the articles taken into the stom- 
ach — it is caused by diet and drink. The stomach being over- 
loaded with food, will, sometimes, be excited to vomiting ; at 
others, run into spasm, and violent colic ; and. at others, im- 
perfectly digest its contents, and pass them into the bowels, 
when, with a great augmentation of fluid, from the liver, or 
other sources, they are hurried on, and expelled, without pain 
or sickness. This is diarrhoea in its mildest form ; and, it will 
be known to every one without further description. But other 
causes often come in, in aid of illy digested food ; or perhaps 
it is more true to say, to hinder the perfect digestion of the con- 
tents of the stomach. For I hold it to be nearly impossible, 



DIARRHOEA. 393 

for a diarrhoea in this mild form, to happen, if the stomach per- 
forms its office of digestion, perfectly. What can look more 
like intelligence, than the operations of the stomach and intes- 
tines in this case ? Food or drink, improper or excessive, is 
taken into the stomach — which finds its powers of digestion 
insufficient to reduce it to healthy chyme — the mass, half re- 
duced, is hurried on — the bowels find its qualities too bad for 
assimilation — violent action takes place, and it is quickly ex- 
pelled. Nor is the food, or offending matter alone expelled, 
every emunctory of the intestinal canal is brought into requi- 
sition — their fluids also, are thrown in, and expelled, so that 
no part of the rejected matter shall, by possibility, be taken in- 
to the system. The production of a common diarrhoea, is con- 
servative. 

Many persons are so subject to attacks of diarrhoea, that 
they are frequently affected from slight irregularity in diet, and 
sometimes, when no irregularity can be detected. In most ca- 
ses, the imprudence in eating and drinking, is obvious. The 
common food of this country — salted meats, milk, butter, and 
bread of corn or wheat flour, rice, garden vegetables, or farina- 
ceous roots, with tea or coffee, will, if taken in moderation, 
hardly ever produce diarrhoea. But add to these, fresh fish, 
fowls, pastry, and especially crabs, or other shell fish ; and 
give, with all this, over fatigue and strong appetite, and the 
production of this disease is almost a matter of course. Putrid 
food, birds strangely fancied by epicures, when kept too long 
in the feathers, and putrid effluvia, are said also to produce 
this disease. 

The most frequent attacks, which I have seen of this com- 
plaint, have been in persons, who, after a brisk journey of two 
or three days, have stopped at a hotel, furnishing a sumptu- 
ous table every day. Excess in eating and drinking, perhaps, 
of water alone, will soon produce diarrhoea. The patient uni- 
formly charges it on the quality of the water, which though it 
be abundantly preferable to that he uses at home, is new to 
him, and better able to bear the blame, than the food which 
he has, in his own opinion, taken in moderation. 

Drinks and fluid aliments are, unquestionably, a frequent 
cause of this disease. Buttermilk, which, in this section of 
the country, is made from milk, and not from heated cream, 
as in some other places, is by many taken as a favorite dessert 
at meals. Others equally fond of it, cannot use it, because of 
its constantly producing diarrhoea. Cider, when newly press- 
ed, is often productive of the same effect. 



394 DIARRHCEA. 

CAUSES AND SYMPTOMS OF CHRONIC DIARRHCEA. 

There can be no doubt, that the frequent recurrence of di- 
arrhoea, in the same person, from the causes above mentioned, 
may frequently produce the disease in its chronic form. The 
cases which I have witnessed, however, do not authorise the 
assumption of these, as the most frequent causes. There is 
something, unquestionably, beyond these occasional causes, 
necessary to produce the aggravated forms of diarrhoea I have 
witnessed. These cases have not in their commencement, 
been distinguishable from common diarrhoea. A few days 
have been sufficient, to excite a reasonable fear, that the attack 
was not likely to pass off so easily. Some fever, great thirst, 
and a tenderness and tumid feeling of the abdomen, showed an 
active state of the disease, if not inflammation. The failure of 
remedies, and especially the aggravation of these symptoms by 
opiates, disclosed their character, and time soon confirmed 
their chronic tendency. These attacks, I am sure in some ca- 
ses, have not arisen from any irregularity in eating or drink- 
ing. They may have arisen from a disordered state of the 
stomach, or other disease of the intestinal canal, previously ex- 
isting. But I suspect there are many cases, arising from cau- 
ses existing in the place of residence of the patient. I have 
never known it to be epidemic ; but, if I am not greatly mis- 
taken, it is much more frequent in some localities than others. 
The city of Richmond, and the valley of the James river, are 
said to furnish more cases, than places elsewhere, with many 
times their population. The States of Alabama and Missis- 
sippi, have furnished me with more cases than accident can, 
in my opinion, account for. 

But from whatever remote cause chronic diarrhoea may 
arise, a disordered state of the stomach, and a highly diseased 
state of the intestines, attend it. It cannot always be said to 
be dyspepsia ; for sometimes the food passes through the stom- 
ach without producing pain or uneasiness. I do not believe it 
is well digested ; but I can offer no proof of the correctness of 
this opinion. Nor can the exact time at which it loses the 
character of acute, and becomes chronic, be assigned, if it 
were material. Time soon settles the question ; and fever, 
sometimes, decidedly hectic, and great emaciation follows. 
The discharges, still frequent, become less copious ; and strain- 
ing, with a disposition to remain long on the close stool, point 
out the diseased state of the intestines. Dissections after 
death, disclose the great extent of ulceration., which previous 



DIARRHCEA. 395 

discharges of pus had rendered almost certain. Sometimes 
the ulceration is extensive, and at others, in small patches ; 
sometimes with broad, and at others, exceedingly small and 
numerous pustules. The ulcers are, in a few cases, so near 
the anus, as to admit of easy inspection, and application of 
remedies ; but the disease is generally seated in the ileum, or 
lowest of the small intestines. In all the cases I have seen, the 
action of the bowels seemed to correspond with the times of 
taking food. Sometimes the passages were so frequent, as to 
render this less obvious ; but at others, the bowels were in 
some degree quiet, till time had been allowed for the food ta- 
ken to pass through the stomach, when the pain, tormina, and 
frequent discharges would begin. 

TREATMENT OF ACUTE DIARRHCEA. 

There are few persons, who, on being attacked with the 
mildest form of this disease, will desire any remedy. It will, 
in such cases, perform its own cure, and may be safely trusted 
to do so. But in cases a little worse, tending to the higher dis- 
eases, cholera ; or the more inflammatory dysentery, remedies 
become necessary. If the evacuations have been full, and 
continued for a few hours, give a full dose of laudanum, say 
sixty drops. If the case seems slight, a less dose will answer ; 
and this will commonly terminate the case. But if it lasts for 
twelve hours, give five grains of calomel, and ten of prepared 
chalk, together, or separate. Give nothing more, unless the 
disease continues till the next day, which it will hardly do. 

TREATMENT OF CHRONIC DIARRHCEA. 

In no case is the skill of the physician of more importance, 
than in this formidable disease. Besides the cases resulting 
from other fatal diseases ; diarrhoea, when existing alone, often 
rests on organic diseases necessarily fatal. But there are ma- 
ny instances in which this is by no means the case, and 4 in 
which skill and proper remedies reap their noblest reward. 

Proper food. Let no absence of the common symptoms of 
dyspepsia, hinder the adoption of a regimen of the strictest 
kind. Let that only be eaten which is easiest of digestion, 
least stimulating, and most thoroughly taken up, after diges- 
tion. Thus you will lessen fever, supply nutrition, and pro- 
tect the lower bowels from unnecessary action. These desi- 
rable qualities cannot all be supplied in any one article of 



396 DIARRHCEA. 

food ; but we must keep the great objects already mentioned 
constantly in view. It is not a mere dyspepsia, but a far more 
inflammatory disease, of which we are treating. Therefore, 
use bread in preference to meat. The bread should be of fine 
flour, not unbolted ; but it should be stale, or unleavened — 
that is, crackers, hard biscuit, or something like it. These 
may be eaten in any manner, that is, dry, or with boiling wa- 
ter poured over them to make them soft. Rice deserves per- 
haps the first place amongst bread stuffs, and needs only the 
simple process of boiling. I consider these the best ; but some 
variety is necessary in a disease so tedious, and I have allowed 
Irish potatoes, and bread of other descriptions, carefully guard- 
ing against a repetition of them, if found not to agree with the 
patient. 

If any animal food is allowed, chicken and small birds, 
doves or partridges, answer best. The patient should be much 
better, before the flesh of large animals is allowed. But ani- 
mal jellies, and milk, should be tried, unless the inflammation 
and fever are great. Buttermilk would seem to promise little ; 
but I have seen one of the worst cases I ever knew cured, 
grow rapidly better while the food of the patient was only but- 
termilk and stale bread. I object to animal soups, having 
found them decidedly hurtful, even when most agreeable to 
the patient. Salt is not to be left out of the food of patients, 
in this complaint ; but I have nothing to say in favor of spices, 
or other condiments. I have known a patient who took two 
grains of cayenne pepper in a pill, complain that it burned him 
like fire, through the whole intestinal canal. 

It is impossible to detail the variety of food which may be 
allowable ; but the patient must be exhorted to adhere closely 
to his regimen ; and I am decidedly against his eating more 
than twice a day — breakfast and dinner. If any thing at sup- 
per, let it be a cup of black tea, without bread. A gentleman 
used a little sugar and milk, with boiling water poured on it — 
the hot water tea of our nurseries — and found it greatly pref- 
erable to black tea, or any thing else he had tried. He had 
contracted the disease in Alabama, has had it many years, 
and is still, I believe, a sufferer. 

Clothing. The healthy function of the skin is greatly inter- 
rupted in this disease ; and its dry, tawny, and sometimes 
ashy appearance, points out the necessity of warm clothing 
and flannel, to keep up, by gentle friction, the insensible per- 
spiration. The useless, or hurtful visits so frequently paid by 
these patients to watering places, admonish us to avoid exces- 



DIARRHCEA. 397 

sive ablutions ; but when the disease has not already produced 
ulceration of the bowels, and is kept up by indigestion, a guard- 
ed use of warm bathing, with friction on the skin, may be 
beneficial. These remedies should not be continued unless 
found manifestly beneficial. 

In connexion with food, it is proper to add a word on the 
subject of the frequency, with which patients in diarrhoea, 
have acidity of the stomach. Sometimes the acid, from its ir- 
ritating quality, seems to cause the frequent discharges from 
the bowels ; at others, it seems to attend a temporary costive- 
ness, which is not uncommon in this disease. In either event, 
it is to be avoided, if possible, by great care in taking only such 
diet as has not been found to produce it. But if the acid is 
found to be present on the stomach, lime water, or prepared 
chalk should be taken according to its intensity. I object to 
magnesia, or Seidlitz powder, or any neutral salt in this case. 

Exercise is not to be considered a remedy for diarrhoea, 
farther than it promotes digestion, and invigorates health. But 
it is easily perceived, that, in a disease so full of irritation, and 
productive of fever, this remedy is of very limited application. 
It is, therefore, to be moderately and sparingly used. 

Leeches and blisters must be mentioned, in the account of 
the remedies for diarrhoea. They are useful in the early stage, 
when the local irritation first manifests itself, and should be 
applied as near the seat of the irritation as possible. I doubt 
the great importance, which some have attached to the appli- 
cation of leeches near the anus, in preference to any point near 
the seat of the inflammation. I cannot say that I have tried it 
sufficiently to decide the question ; but I think it not material. 

Purgatives, would seem to be properly forbidden in diar- 
rhoea ; but experience warrants a guarded use of them, in the 
first stages of the disease. Rhubarb, magnesia, and the neu- 
tral salts, have been used, in some cases, with advantage. 
They seem to assist in the removal of offending matter from 
the bowels, and operate perhaps more beneficially in changing 
the state of the secretions thrown into them. They are to be 
administered in small doses, and not too frequently repeated ; 
and they are, especially, not to be allowed to operate exces- 
sively ; but are, in all cases, to be checked by laudanum, in 
doses of twenty or thirty drops, repeated if necessary. 

Calomel, has been too much used, and is too important a 
remedy in diarrhoea to be passed over without particular no- 
tice. It is obvious that it cannot cure the organic injuries, ma- 
ny times found in the viscera of patients who die of diarrhoea ; 



398 DIARRHCEA. 

but the exact nature of these, is seldom known before death ; 
and the physician who allows his patient to sink under chronic 
diarrhoea, without giving him a fair trial of this invaluable 
remedy, assumes, as I think, a fearful responsibility. It is 
true, I have seen some who could not take calomel, even in 
small doses, without exciting the bowels to violent action, pro- 
ducing many and wasting discharges ; and I have, in a few in- 
stances, seen the same patient, without any obvious cause, af- 
ter a few weeks spent in using other remedies, return to this, 
with the greatest advantage. A salivation I think is generally 
unnecessary, and it is, in these cases, not easily brought on. 1 
prescribe calomel alone, or with opium, especially with Do- 
ver's powder ; say ten grains of calomel, with thirty grains of 
Dover's powder, to be divided into six doses, and taken in the 
course of three days. This may be done early in the disease ; 
and in cases of long standing, the same remedies given in smal- 
ler doses, at longer intervals, have been found effectual. The 
benefits of calomel are seldom felt, unless it produces its pe- 
culiar discharges of thick bilious matter from the bowels. 
These seldom fail to bring with them great relief — they are to 
be noticed, as the signal of suspending, or greatly reducing the 
quantity of the remedy administered. 

Opium is a remedy of great value in diarrhoea. In the first 
stage, I have no doubt it often checks, or cuts off the disease 
which, without its use, would become chronic, and sometimes 
fatal. It is to be administered, in large doses at long inter- 
vals — from thirty to sixty drops of laudanum, once or twice in 
twenty-four hours, is commonly sufficient. But in this linger- 
ing disorder, in the whole course of which opium, in some form, 
will be found necessary, the doses to be given, the time of giv- 
ing them, and the preparation of the article which may be used, 
admit of infinite variation; and must be regulated by the judg- 
ment of the practitioner, and the experience of the patient. 

Astringents, from their known quality of suppressing dis- 
charges, must have a prominent place in the treatment of diar- 
rhoea. Oak galls, the most powerful of the vegetable kind ; 
and, in my opinion, the most valuable, may be given in pow- 
der, from five to twenty grains at a dose, two or three times a 
day. It may also be given in decoction, made by boiling half an 
ounce of coarsely powdered galls in a quart of water, and giv- 
ing a table spoonful at a dose. A remedy essentially the same, 
may be made by boiling about two ounces of pounded red oak 
bark, in the same quantity of water, for a quarter of an hour, 
and giving the same quantity at a dose. Kino and catechu 



DIARRHOEA. 399 

are remedies of similar properties, and may be given in pow- 
der, in doses of from ten to twenty grains. They are conveni- 
ently administered in syrup. An infusion may be made of 
either of these articles by pouring on half an ounce of it, a pint 
ot boiling water, and pouring off the dose from the vessel with- 
out shaking. A table spoonful, or half an ounce, is the dose. 
Many articles might be added to this list ; but I fear it w r ould 
be less improved than enlarged by it. Yet it must be confes- 
sed, that in this class of remedies more than in others, a weak- 
er seems to succeed at times, after the strength of the stronger, 
has been tried in vain. I knew an obstinate diarrhoea, which 
had resisted the strongest mineral and vegetable astringents, 
yield promptly to a decoction of the root of bear grass, (yuca 
filamentosa) taken in doses of half an ounce, three or four 
times a day. 

Of the mineral tonics, acetate of lead probably deserves the first 
place. It may be given in doses of from one to five grains, 
two or three times a day. It is unattended with danger, and 
has often been hindered from producing its beneficial effects by 
the over prudent practitioner, giving after it, purgatives of va- 
rious kinds, to prevent a possible attack of painter's colic, 
which is thought to arise from taking lead. Experience has at 
last rendered it almost certain, that this preparation of lead 
never produces this disease. Sulphate of alumine, (common 
alum) is also a valuable astringent, and may be safely given in 
doses of thirty grains or less. 

On the use of astringents in diarrhoea, I have to remark, that 
they are the most uncertain of remedies. That given in over 
doses, they are often active purgatives themselves ; and when 
they succeed in suppressing the discharge, it is apt to be done 
too suddenly, and to be productive of various ills. The worst 
of these is dropsy, which, I have no doubt, is often the inevi- 
table sequel ol the complaint, but sometimes, I fear, precipi- 
tated by too early and free use of astringents. My practice is, 
to forbear the use of astringents, while the presence of fever 
might render their administration questionable — to administer 
them in small doses, and at long intervals ; and to give opium, 
or some of its preparations, at any time the remedy seems in- 
dicated, regardless of the use of astringents at the same time. 
The aphthae, and sometimes very different eruptions on the 
tongue, and in the mouth, are best treated by the application 
of a solution of thirty grains of lunar caustic, in an ounce of 
water. This should be applied once in two or three days, with 
a camel hair pencil, or some similar instrument. Similar ap- 



400 DISEASES OF THE CCECUM. 

pearances around the anus, or within, if they can be exposed, 
are to be treated in the same way. 

Almost every remedy which has been mentioned in this dis- 
ease, may be administered by way of injection, if from any 
cause, it is thought preferable. The dose given in this way, 
is three fold, and should be given in as small a quantity of fluid 
as practicable. 



DISEASES OF THE CCECUM. 

About three inches of the commencement of the large in- 
testine, having attached to it a process not much differing from 
the little finger in size and length, is called ccecum. 

Its diseases had not attracted much attention, till they were 
taken up by Doctor Copland, who, with his usual ability and 
research, has shown them to be too important to be omitted, in 
any treaties on the diseases of the alimentary canal. The ali- 
mentary matters taken into the stomach, having been digested, 
and, in their passage through the small intestines, divested of 
their nutritive portion, are passed into the ccecum by an open- 
ing in its side, the end having no opening, or as anatomists ex- 
press it, being blind. A valve near this opening shuts off all 
connexion between this matter and the small intestines, through 
which it has just passed. It is now feculent or excrementi- 
tious, acquires its peculiar odour, becomes of a darker color, 
and, for ought that is known, might be advantageously dis- 
charged from the body. The ccecum, situated in the right 
iliac region, near the groin, with one of its openings in its side, 
and the other a prolongation of itself, has a great resemblance 
to the stomach in its figure ; and writers have fancied there 
was here performed, an important additional digestive pro- 
cess. But of this there is no proof. I consider this part of 
the intestinal canal, as a mere reservoir of excrementitious mat- 
ter, enlarged, as well as the rest of the large intestines, for the 
convenience of the individual, enabling him to retain these 
matters to a convenient time for their discharge. The princi- 
pal change they undergo in their passage through the large in- 
testines is the loss of their fluidity, so that in a healthy indi- 
vidual they are discharged in a state approaching to solid. 
The course of the great intestine, from the blind head of the 
ccecum, is upwards, arching over by the pit of the stomach, 
and passing down on the left side. Its contents, while the in- 



DISEASES OF THE CCECUM. 401 

dividual is in an erect position, must flow upwards, against 
gravitation. They are fluid, and require the perfect action of 
the intestines for their removal. Small hard substances in- 
cautiously swallowed sometimes lodge here. Cherry stones, 
and other similar matters, have been known to produce much 
injury by their accumulation at this point. But the most com- 
mon cause of disease, from the detention of foreign matter in 
the ccecum, is costiveness. The accumulations that some- 
times happen in this way, are very large, and produce inflam- 
mation and its consequences. These disorders we intend to 
consider in this chapter, leaving the diseases of this organ 
which may arise in dysentery and other diseases, to be treated 
of under their proper heads. 

EXCREMENTITIOUS ACCUMULATIONS IN THE C CECUM. 

Costiveness is, I have no doubt, much oftener attended with 
great accumulations of matter in the ccecum, than is common- 
ly supposed. I have not thought it important, in slight cases, 
to examine the state of this intestine ; but when from the re- 
cumbent position of my patient, I have found it convenient to 
do so, I have not failed to examine the ccecum, and the ascend- 
ing colon, as it arises from it. And I have frequently found a 
great accumulation of hardened faeces, with some tenderness 
of the part which had not been noticed by the patient before. 
Nor had any pain been felt in the part. The examination un- 
der these circumstances is very easy, if the muscles of the ab- 
domen are relaxed by the patient lying with the knees drawn 
up. If there is not too much corpulency, the intestines can be 
plainly felt, like a stuffed sausage. A little friction, with gen- 
tle pressure on the part, will often cause the contents of the in- 
testine to pass forward, so that in five or ten minuteslt can no 
longer be felt. I have felt air, pass on instantly from pressure, 
so as to remove the tumour immediately. 

When the accumulation is a little greater, it is felt as a more 
extensive doughy enlargement. The right side is more promi- 
nent than the left, and symptoms of disease occur. Violent 
pain, and colic in its worst form, are said to attend the worst 
cases of fcecal accumulation in this part. 

TREATMENT. 

Cathartics will of course be sought for to remove the accu- 
mulation of fcecal matter from the bowels. The best by far is 
calomel. Give twenty grains in syrup ; and, six hours after- 
26 



402 DISEASES OF THE CfECUM. 

wards, begin with a wine glass of senna tea, with a tea spoon- 
ful of Epsom salts every two hours, as long as it may be ne- 
cessary. If the case is of long standing, and the patient weak, 
the salts are to be left out, and the senna tea given at longer 
intervals. It is seldom necessary to give any stronger remedy. 
But there have occurred cases, in which the accumulation 
of faeces in the coscum have become very great, and yet no 
alarming inflammation of the part has occurred, leaving the 
physician full time to procure their discharge by the safest 
means in his reach. In these cases, medicines pass the bow- 
els, and the physician is often deceived, supposing that a thor- 
ough evacuation has taken place. The case becomes more 
distressing — the stomach rejects whatever is taken, and, at 
length, extreme danger would arise. In such cases, Doctor 
Copland judiciously advises the use of injections, containing 
castor oil, soap, or other solvent materials. These should be 
used in very large quantity, and retained in the bowels as long 
as possible, and repeated, from time to time, till the effect is 
produced. The physician should recollect, that after calomel, 
or calomel and opium in large doses are given, the injec- 
tions are the main reliance. They are to be presisted in while 
a hope remains. The accounts given by authors of the quan- 
tity of hardened fasces dislodged in such cases is truly aston- 
ishing. I have never met with a single case of extraordinary 
amount, or of any other foreign body besides faeces, in these 
cases. But I have seen, after the faithful administration of 
these means, a discharge of scybala, or bails of hardened 
faeces, which recurred from day to day, for two or three days, 
leaving the bowels in a state of great weakness, and the pa- 
tient prostrated in a remarkable degree. 

INFLAMMATION OF THE COSCUM. 

The varieties of inflammatory disorder which may attack 
the ccecum, do not appear to me to reward the diligence of 
Doctor Copland, in unravelling their intricacies. Independ- 
ently of the uncertainty which must ever rest on the attempt 
to demonstrate, whether the inflammation is of the vermiform 
appendage only, or of the inner coat, or whole substance of the 
tissue, it appears most useful to divide this disease into its 
chronic and acute forms. Nor will this division relieve us al- 
together of the intricacy of our subject ; for the acute form will 
seldom occur without a violent attack of colic or ileus ; and the 
chronic will as uniformly be attended with constipation. But 



DISEASES OF THE CCECUM. 403 

so far as I can, I shall point out the symptoms and remedies of 
inflammation of the ccecum, in the two forms mentioned. 

ACUTE INFLAMMATION OF THE CCECUM, 

From whatever cause, produces "violent pain in the right 
iliac region" — near the right groin ; "and is frequently attended 
with a burning sensation, and a most exquisite tenderness." 
Fulness in the right, and lower portion of the abdomen, and a 
sense of numbness extending downwards to the thigh, are a com- 
mon attendant of this inflammation. The pain may often ex- 
tend above and across to distant portions of the abdomen ; but 
they are still fixed at the point above described as the situa- 
tion of the ccecum. These symptoms may occur in dysen- 
tery, or in colic; but they may also occur when neither of 
these diseases is present, and terminate as a common inflam- 
mation, by abscess, or resolution, or gradual decline. 

TREATMENT. 

Acute inflammation of the ccecum, is to be treated upon the 
general principles of treating inflammation. Bloodletting, with 
leeches and cold applications to the part most affected, are to 
be used and persisted in, till the symptoms give way. Cup- 
ping is as available as leeches, and not less beneficial in its ef- 
fects. If the disease proves obstinate, general bleeding should 
be discontinued after the first or second time, and leeches and 
cupping continued, according to the strength of the patient. 
Cold applications by means of cold water will also have a 
powerful effect in removing this complaint. If the case is still 
further protracted, a blister should be applied over the most 
prominent part of the abdomen, or the point nearest the pain. 
The internal remedies which should be used, will be very 
much controlled by the state of general disease, or other intes- 
tinal disorder which may be present. If it be dysentery, or 
colic, neither disease will be well treated without full doses of 
calomel ; and the inflammation of the ccecum will not forbid it. 
If neither of these diseases is present, the remedies most 
proper will vary a little. Antimonial powders, each contain- 
ing one fourth of a grain of tartar emetic and ten grains of salt 
petre, may be given, from four to eight in twenty-four hours, 
according to the urgency of the case. Vomiting and sickness 
at the stomach do not forbid the use of this remedy, unless the 
strength of the patient is greatly exhausted. Nor should this 



404 DISEASES OF THE CGECUM. 

remedy be too readily given up, from appearances of nausea 
and debility. I have seen it, even when it produced occasion- 
al vomiting, afford great relief from a tormenting nausea. But 
should the tartar emetic prove too irritating to the stomach, let 
it be left out, and the powder of nitre alone used. 

CHRONIC INFLAMMATION OF THE CCECUM. 

This is an insidious disease, depending most frequently on 
a loaded state of the organ, from costiveness; but, in other cases, 
tending to ulceration. The patient loses flesh, and feels occa- 
sional pain in the region of the ccecum. Pains resembling colic 
are also felt in other parts of the abdomen — the bowels become 
irregular, sometimes being constipated, and, at others, having 
offensive fluid discharges. The examination of the abdomen 
presents nothing remarkable till we reach the right iliac region, 
" where pressure occasions uneasiness, and a deeply seated 
fulness and hardness are usually detected." Ulceration is at- 
tended with dark, offensive, bloody stools. When the inflam- 
mation is attended with no ulceration, the disease is less dan- 
gerous ; but ulceration, if brought on by slow and insensible 
degrees, is extremely dangerous. 

TREATMENT. 

If the disease is attended with costiveness, or the presence 
of other foreign matter, the first consideration is to be given to 
its removal. Injections form the safest means of accomplish- 
ing this, and should be used with great perseverance. Success 
can hardly be reckoned on without a full dose or two of calo- 
mel. But having once freed the ccecum from indurated faeces, 
great reliance may afterwards be placed in injections for pre- 
serving proper evacuations. The object will be to preserve a 
proper activity of the bowels, by the mildest possible means. 
But this will not hinder the use of salt petre, in doses of ten 
grains, from four to six times a day ; and there are few reme- 
dies in which I should place more reliance, in this disease. 
The use of leeches, cups, and bloodletting, will depend on the 
strength of the patient. They are the best of all remedies for 
the removal of local inflammation. This disease, when it does 
not give way under a well regulated diet and proper state of 
the bowels, will offer no great hopes under other treatment. 
But 1 should never rest satisfied in this case, till my patient 
had a fair trial of a gradual, but decisive use of mercury. It 



CONSTIPATION. 405 

should be applied in ointment, over the affected part daily ; 
and from two to four grains daily given in pills, till a salivation 
is brought on. No state of despair should hinder this trial 
of a great remed}'. 



CONSTIPATION— STEGNOSIS. 

Constipation has been denned — " A state of the bowels, in 
which the evacuations do not take place as frequently as usual ; 
or are inordinarily hard, and expelled with difficulty." This, 
within certain limits, cannot be considered a disease ; and dif- 
ferent individuals, or the same person at different times, w 7 ill 
enjoy health under very different states of the bowels, in this 
respect. I have known persons who had evacuations twice 
daily, and others not having an average of one in three or four 
days ; and yet neither seemed to suffer the slightest inconve- 
nience. The healthy standard may, however, be set down at 
a daily evacuation ; and I think the morning the best, and the 
safest time. 

The great variation of food, in quality and quantit} r , which 
the stomach is compelled to digest, and the bowels to assimi- 
late or expel, may readily be supposed capable of producing 
many disorders of these organs. Costiveness, perhaps the 
most frequent of these, is, in itself, a small evil in compaiison 
with others which arise from it. But from its frequent oc- 
currence and long continuance, its complicated relations, and, 
in some cases, serious consequences, it becomes a matter of 
the first importance to notice its beginnings, and avoid or re- 
move its causes. 

The most obvious cause of costiveness, is debility in the 
muscular action of the large intestines, in which alone consti- 
pation exists. From this cause, the feculent matter which has 
passed through the small intestines, is suffered to pass on too 
slowly, and thus to accumulate, producing distension and in- 
creased weakness. The absorption of the fluids naturally ex- 
isting in these matters, but hardens and dries the mass, and 
renders its expulsion more difficult. These causes seem of 
themselves sufficient, in many cases, to account for all the 
symptoms. ^ But close observation warrants the addition of 
many additional causes. Want of exercise, or employments 
confining individuals to inconvenient or unalterable positions, 
are often causes of this complaint. Improper food and im- 



406 CONSTIPATION. 

proper medicines, must come in for a heavy responsibility, in 
relation to this subject ; but my views will be better explain- 
ed when the remedies are treated of. 

Costiveness seldom makes its attack suddenly. Gradually 
a hardness or dryness of the evacuation will be seen. The 
discharges become less frequent, and flatulence and oppres- 
sion about the abdomen, become troublesome. Slight pain is 
felt in the course of the large intestine, from near the right hip 
upwards, and across near the pit of the stomach, and down- 
wards on the left side. In persons not too corpulent, the vol- 
ume of the distended intestine is easily felt, when a recumbent 
posture is taken and the muscles relaxed. Nature makes 
greater efforts to relieve herself. The contractions of the in- 
testine become violent ; sometimes painful. The faeces are 
discharged, compressed as a piece of tape, or rounded into 
balls or irregular masses. In a short time, the discharges be- 
come still more difficult. The excited intestine throws out 
mucus which facilitates the discharge. If these symptoms 
continue, a state of disease follows. Dysentery, with fever 
and intolerable pain, which is only relieved by active reme- 
dies. Enormous collections of feculent matter, discharged 
with great difficulty, even by the most powerful means. Ner- 
vous disorders as indescribable as intolerable; and to crown 
all, dyspepsia and frequent attacks of violent colic. Piles and 
other local disorders are often brought on. Such is the train of 
diseases which constipation may produce ; not in a single case, 
or in a short time, but often enough to render its proper treat- 
ment highly important. This account, condensed as it is, will, 
I trust, serve to enable every sufferer to understand the char- 
acter of his disease. 

The treatment of colic, dysentery, dyspepsia, and other dis- 
orders depending on, or attended with costiveness, cannot be 
entered on here. They will be spoken of, each in its place. 
But the remedies and measures necessary to prevent and re- 
move constipation, are our present subject of consideration. 

The means of prevention are obvious from the suggestion of 
the causes. Exercise in the open air, especially on horseback. 
Nearly two hundred years ago, Doctor Sydenham loaned a 
poor sufferer a horse to ride a " very long journey," that he 
might be freed from attacks of colic, brought on by torpid bow- 
els. No better advice can now be given. But exercise is not 
restricted to riding on horseback. It is to conform to necessity 
or circumstances. A change is often beneficial to those who 
seem to have had sufficient exercise. But this remedy may 



CONSTIPATION. 407 

be carried loo far. Violent and long protracted labor is no 
remedy for airy disease. 

A proper diet may be placed amongst the preventive reme- 
dies of costiveness. Several vegetables seem to have a slight 
cathartic effect, and have been highly extolled. Spinach and 
the leaves of turnips boiled, are perhaps the best. They can- 
not always be said to be exempt from the production of flatu- 
lence. Of bread, the coarsest is the best. Unbolted flour is 
used for making the celebrated Graham bread, now regarded 
as the best of all bread for dyspepsia and constipation. In- 
dian corn meal, rather coarse than fine, baked hard and thin, 
is, in some cases, a better article, and to those accustomed to 
it, far more palatable. Small hominy from the same grain, is 
decidedly favorable to the expulsive action of the bowels. But- 
ter, if good, is allowable to all who can take any animal food ; 
but no oil or lard should be put into bread before baking ; nor 
is leaven or fermentation a benefit, but a decided injur}', unless 
the bread is allowed to remain at least a day before it is eaten. 
All kinds of meat should be salted and cured, before the} 7 - are us- 
ed by persons with weak or torpid bowels. This will be ques- 
tioned ; but I risk my reputation on the event of the trial. Ba- 
con, or pickled pork, not too old, is the best. Mutton, or veni- 
son prepared in the same way, is also very good. Beef is more 
stimulating, and less allowable. All fresh meats, poultry, fish, 
or small game are bad. Coffee, tea, and sugar, are bad. Milk 
is very good for some; and, for no obvious reason, very bad 
for others. Molasses is a bad and indigestible article of food, 
but carries with it, in its uncrystalizable sugar, a mild cathar- 
tic, and is sometimes allowable. Fruits and melons are of a 
doubtful character. They should be sparingly used; audit 
will be found that the slight cathartic effect sometimes brought 

o o 

on by fruit, is seldom beneficial. 

It will be observed, that the articles of diet recommended 
are not always the most nutritious, or easily digested. The 
feverish and irritable state of patients laboring under this dis- 
order, forbid large quantities of nutritious food. The small 
quantity of feculent matter left after the digestion of well cook- 
ed meat, and the finer preparations of bread or sugar, leaves 
the larger intestines so little to act on, that they become torpid 
from inaction. This, in the higher classes, is probably the 
most common cause of constipation. A regimen for the relief 
of torpid bowels, should contain some coarse and indigestible 
matter. The bread above recommended is far better than 
vegetables or fruits containing cathartic powers. Let the food 



408 CONSTIPATION. 

be coarse. The common laborer whose bread is of coarse con. 
meal — whose meat is bacon — who uses neither tea nor coffee, 
sugar nor rice ; nor yet game, poultry, or fish ; and whose 
vegetagbles are coleworts or peas and sweet potatoes, seldom 
requires bitters of hiera picra, or pills of aloes to remove cos- 
tiveness. An observing friend, with a fair opportunity of judg- 
ing, has seen the ample, not to say enormous discharges of this 
class, when compared with the pampered and well fed. In 
all matters relative to diet, the patient -must be allowed a 
choice, when certain articles are found by experience, to suit 
him better than others. That which is bes*t cannot with cer- 
tainty be known till it is tried. 

The medicines to be given in cases of costiveness are few. 
Cathartics, for the removal of large collections of feculent mat- 
ter ; aperients, or gentler laxatives ; and tonics, to restore the 
strength of the muscular fibres of the intestine. 

Where there is reason to believe that the bowels are in an 
overloaded state, a dose of calomel, ten or fifteen grains should 
be given. If it operates more than once in twelve hours, give 
no cathartic after it. If it fails to operate, give castor oil, a 
table spoonful every two hours, till it operates. If the oil is 
objected to, rhubarb and magnesia, Epsom salts, or a Seidlitz 
powder, may be substituted. But the exchange is bad, and 
the oil should, if possible, be taken. In some cases, considera- 
ble pain will follow the operation of the cathartic ; and there is 
no objection to seeking relief in the use of paregoric or lauda- 
num. A tea spoonful of paregoric, or twenty drops of lauda- 
num, will be sufficient in ordinary cases. 

Having procured a proper operation from the bowels, reme- 
dies to prevent a recurrence of constipation must be given. 
And the great difficulty is, to give such as will prevent the ac- 
cumulation of feces in the bowels, and not produce a prostra- 
tion of their natural powers, if too long persisted in. In the 
first place, I object most positively to all hydragogue cathartics, 
such as jalap, salts, or magnesia. Seidlitz powders have pro- 
duced more cases of costiveness, than any other remedy I have 
known ; and it is a matter of real joy, to find them going out of 
fashion. The Saratoga water, so extensively used, is but lit- 
tle better. Aloes is the principal article in the best pill I am 
acquainted with. Take of aloes, sixty grains ; gamboge, ten 
grains ; mix, and divide into sixteen pills. This prescription 
may be used for weeks, where it does not cause evident pain 
and irritation, at the time of evacuations. One or two pills a 
day may be given, and should never be allowed to produce 



CONSTIPATION. 409 

more than one evacuation a day. It must be laid aside as soon 
as the bowels are found to act of themselves ; and the excel- 
lence of the remedy consists in its producing action of the bow- 
els, longer than any thing else I know, and never of itself in- 
ducing costiveness. But there are many persons who cannot 
use this stimulating pill ; because of the irritation, and some- 
times fever it produces. To such I recommend the following : 
Take of ipecac, thirty grains; rhubarb, sixty grains; mix, 
and divide into twenty-four pills. Of these pills, take one by 
one, three or four a day, as the case may require. If they pro- 
duce nausea or vomiting, the quantity of ipecac may be lessen- 
ed ; but by taking the pills some time after eating or at bed 
time, they will probably not cause vomiting. These pills are 
of great mildness, and may be continued for a great length of 
time. 

There are cases in which, from irritation of the intestines, 
more or less fever is almost constantly present. In these cases, 
give the following : take of calomel, thirty grains ; tartar emet- 
ic, six grains ; mix, and divide into twelve pills. Give these 
one by one, so as to produce two or three evacuations daily, 
for two or three days, or till the fever seems to have given way. 
Then give the pills of ipecac and rhubarb as above directed. 
Calomel, or blue pill, has not been a leading part of the reme- 
dies I have recommended for costiveness. It is only when the 
disease becomes complicated with other disorders requiring 
the mercurial treatment, that I advise those remedies. Cos- 
tiveness of itself does not require it. 

Several remedies which seem to have only a mechanical 
operation, have been recommended for costiveness. Injec- 
tions of cold water, or vinegar and water, used every morning, 
have, in some cases, superseded all other remedies. I have 
known several cures in bad cases, effected by this simple 
means. Mustard seed, swallowed whole, was at one time ex- 
tensively used ; and I have no doubt is a good remedy in ma- 
ny cases. I attribute no medical effect to it, but suppose it to 
act as the bran in the Graham bread, and perhaps the coarser 
portions of the hard baked corn bread I am so much in favor of. 

Tonic medicines become useful when the costiveness is les- 
sened. They should not be urged on bowels too tender, or on 
a system too feverish. It is a common practice to combine 
them with cathartics. This I never do. I think their good 
effects are often hindered by such combinations. Extract of 
gentian in pills, is perhaps the best tonic in these cases. Rub 
with the mass a little powdered ginger, and make into pills 



410 PILES. 

of the common size, about four grains in weight. Of these, 
from three to six a day may be taken. Iron is also a favorite 
prescription. The common carbonate, or what is belter, the 
precipitated carbonate, may be in the same manner formed in- 
to pills as follows : take of precipitated carbonate of iron, sixty 
grains ; powdered ginger, thirty grains ; powdered gum Ara- 
bic, twenty grains ; mix, and make into twenty pills. These 
pills to be taken in the same manner as those above recom- 
mended. These are the best tonics with which I am acquaint- 
ed ; but the patient should not expect too much from them. 
They cannot be safely used in cases with too much fever ; and 
the}' - can never authorise the neglect of the more effectual ton- 
ics, well directed exercise and regimen. 



PILES— HiEMORRHOIS. 

This is a disease of the bloodvessels of the rectum ; attended 
with great pain at the anus, tumours, distension of the veins, 
and commonly, but not always, frequent discharges of blood. 

But a more minute account of its great variety of symptoms 
is necessary. The patient, commonly in the prime of life, is 
affected with drowsiness, cold extremities, and a copious flow 
of limpid urine. A heavy bearing pain at the anus, which, on 
taking exercise, is greatly aggravated, follows. He feels com- 
pelled to evacuate the contents of his bowels ; but, on making 
the effort, finds it unavailing, or at most productive of no relief 
to his sufferings. A horizontal posture is instinctively taken, 
and a degree of relief obtained. Days are passed in this con- 
dition, which seems to lead to a certain crisis, when all the 
symptoms disappear. In this mild form, this disease often ex- 
ists for a great length of time, always appearing to clear off and 
relieve the system from a state of lethargy and manifest disor- 
der of the digestive organs ; and it would be unsafe to deny, 
that to some individuals it is a salutary and beneficial opera- 
tion. 

Other, and more formidable symptoms attend its farther 
progress. It recurs frequently; and sometimes periodically. 
The pain becomes greater, and a degree of fever, with great 
pain of the back, extending down the thighs, is felt. On 
seeking relief by a discharge from the bowels, blood is seen to 
accompany the discharge. This, although sometimes absent, 
is considered the characteristic feature of the disease. Piles 



PILES. 411 

arc, with few exception?, a flow of blood from tumours or dis- 
tended veins at the verge of the anus. Sometimes those tumours 
arc external, and easily seen. — at others, they are within, and not 
so easily discovered. These S} r mptoms admit of indefinite ag- 
gravation. The discharge of" blood becomes, in some cases, 
enormous. The health of the subject gives wa}*. Debility, 
pallid complexion, impatience and irritability of temper, des- 
pondency, palpitation of the heart, with other and more fatal 
disorders, too frequently terminate the case. 

The local disorders attending piles, have been found ex- 
tremely various. In aggravated or long standing cases, 1 be- 
lieve tumours, external or internal, are always present. They 
are of every variety in form, color, and consistence. Those 
which are external, are, at first, commonly blue, and appear 
to be a distended vein. Not unfrequently they are formed 
within ; but becoming large, and forced out with discharges 
from the bowels, they are not returned, and remain external. 
Time, exposure, and pressure, produce in them great altera- 
tions. Some become solid ; others are vascular in the highest 
degree. Some are elongated with small necks ; others globu- 
lar, and others with broad and extended bases. Their size 
and number are, in some cases, remarkable. I have seen a 
globular tumour growing more than an inch within the anus, 
of more than one inch in diameter, and yet having a very small 
neck. In other cases, a tumour of equal size will have a base as 
broad as itself. It is not easy to say how far up the intestine, 
the disorder may extend. Dissections have shown the lining 
membrane, for a great way up, as well as the veins, in a state 
of disease. 

REMEDIES. 

Piles are commonly a disease of the constitution. They 
appear under almost any circumstances. I have found them 
worse in persons in the prime of life — becoming manifestly 
better as age came on. Many seem to enjoy the highest 
health, when subject to frequent attacks ; and some, even 
when those attacks are attended with considerable loss of 
blood. 

These facts suggest a doubt of the necessity of interfering in 
every case of piles. The doubt is stronger where the dis- 
charge has been of long standing, or there is reason to suppose 
it serves as a substitute for other necessary evacuations. Giv- 
ing to these reasons, and the high authority which has sustain- 
ed them, all respect and deference, I am bound to say, they 



412 PILES. 

are not sufficient to justify withholding remedies from these 
great sufferers. Under the excess of these discharges, and 
the harrassing pain and disorganization of the affected parts, 
the health gives way, and life is not unfrequently the sacrifice. 
The danger on this side, is, in my opinion, far greater than on 
that of the cases relieved by remedies. Art, in extreme cases, 
furnishes substitutes for suppressed discharges, such as blis- 
ters, issues, or cathartic medicines and bloodletting. Relying 
on these, in case of necessity, I should, in every case of piles 
with dangerous symptoms, use all possible means to arrest 
them. This is the course which offers the best and most sat- 
isfactory result ; and the sufferer has a right to a fair trial of 
it, if his danger is not thereby manifestly increased 

Having determined that it is our dut} r to arrest and cure 
piles, as well as other disorders, it becomes important to re- 
move, or obviate, such of their causes as it may be in our power 
to control. The first and most obvious cause of this disease, 
is costiveness. This should, by all means, be remedied. I 
shall not at this time, dwell on the means of effecting this ; but 
refer the reader to remarks made in another place, on that sub- 
ject. The occasion is suitable, however, for introducing the 
observation, that costiveness is oftener charged w r ith causing 
piles, than justice warrants. A medium state of the bowels, 
is unquestionably best. But I have oftener seen this disease 
brought on by too free action of the bowels, than by costive- 
ness. Every one must have observed the injury produced in 
piles, by too frequent use of cathartic medicines, especially of 
the drastic and stimulating kinds. My advice is pointed and 
particular on this head. Preserve, if possible, a middle state 
of activity in the bowels ; but rather err on the side of too lit- 
tle, than too much action. 

An overloaded state of the bloodvessels — plethora, has been 
much insisted on as a cause of hemorrhoids. Bloodletting is 
the most certain remedy for this. But I should not resort to 
it, except I had fear of sudden danger from the want of the or- 
dinary discharge from the disease. Let the patient abstain 
from too much food, and take more than usual exercise. This 
is safe and equally efficient. 

Our remedies for the removal of the causes of piles, would 
be wholly incomplete without due regard to the state of the 
liver. The existence of diseased liver, in persons affected 
with piles, is beautifully explained by the fact, that the blood 
which is returned to the heart by the veins of the rectum, pas- 
ses, by a circuitous route, through the liver. The great length 






PILES. 413 

and small diameter of these veins, together with the flaccid and 
elastic organ through which they run, would lead us to look 
here, if any where, for vessels overloaded and distended with 
blood. In the disease in question, they present facts of this 
kind, in every variety. A simple enlargement of their diame- 
ters to many times their natural size, is common. A natural, 
and I believe a common cause of piles, is a state of the liver 
hindering the return of the blood through it to the heart. So 
far as this depends on over fulness of the bloodvessels, caused 
by " too much food and too little work" it requires no other than 
the remedies of abstinence and exercise, so often insisted on. 
These should never be neglected ; but the functions of the liver 
are too important here to be overlooked. Its secretions are 
easily increased by the use of calomel, or other preparations 
of mercury ; and the relief of the congestion is so immediate, 
that it is too often used to the neglect of every other remedy. 
Four or five grains of calomel, given at night, is commonly 
enough, and should not be followed the next day by any other 
cathartic. Such a dose will not produce salivation, except in 
very rare cases, and then to a limited extent. It is a great er- 
ror to think that the thorough discharge of every particle of 
mercury from the system, is necessary or proper. Its office is 
not performed in a moment ; and I have no hesitation in say- 
ing, that the fears of the ablest men of the profession dictate 
remedies for its speedy discharge, to the great injury of their 
patients. I give five grains of calomel, or its equivalent of 
other preparations, once or twice a week, for an indefinite time, 
without fear. This has, in many hands, accomplished a great 
deal. I give it with no auxiliary cathartic. I know this pre- 
scription will be thought feeble, by some, and rash, by others. 
To those who deem it inadequate, I reply that the sudden re- 
moval of plethora, is not always the best or safest way to pre- 
vent its return. A salivation has been claimed as the great 
remedy by some ; but I think it uncalled for, except the dis- 
ease of the liver requires it. But to those who fear producing 
a mercurial disease, I must say, that thirty years' observation 
has convinced me, that this can happen only from long con- 
tinued salivation, and from that rarely. Without mercury, I 
think the physician almost powerless in piles. With it, his 
powers are so great, that his patients run into the opposite dan- 
ger, of forgetting the great preventive remedies of exercise, ab- 
stinence, and others essential to the restoration of health. So 
much for removing the cause, and preventing the paroxysms 
of piles. But there are cases in which the returns of parox- 



414 PILES. 

ysras, however mitigated, will still take place. The highest 
apparent health will not always prevent this ; and it is to be 
left to a sound discretion, how far remedies are, in these cases, 
to be pursued. The patient should be satisfied with a decided 
mitigation of his sufferings. The treatment should cease, ex- 
cept so far as avoiding the causes of the complaint, and an oc- 
casional remedy, if the paroxysm is severe. I have not dwelt 
longer on this part of the subject, than its importance demands. 
Every subject of this malady ought, in some degree, to under- 
stand its history ; and, especially, to be aware of its dangerous 
tendency. The remedies to be used in the paroxysm, and for 
the relief of the local symptoms, will close what I design to 
say on it. 

The paroxysm of piles, is the time of pain, inflammation, 
swelling, and hemorrhage. The discharge of blood is seldom 
a just cause of alarm, except from its frequent returns, and 
great and exhausting debility. If from these causes, and the ex- 
cess of the discharge, fear of too great exhaustion is enter- 
tained, a horizontal position, with the application of cold water, 
may be resorted to. If the bleeding vessels are external, pres- 
sure is easily so applied, as to suppress the discharge. The 
best internal remedy is sugar of lead, given in doses of five 
grains, in water, every hour, till three or four doses are taken, 
if necessary. Inflammation and tumefaction of the part, are 
best treated by the application of cold water, or soft linen, or 
by poultices, leeches, or other similar remedies. For the in- 
ternal burning pain, and the weight, and bursting pain of the 
tumours, I have found balsam copaiba, in doses of from fifty to 
one hundred drops, repeated in one or two hours, if necessary, 
the best remedy. The relief sometimes afforded by it is spee- 
dy and striking. Spirit of turpentine, in about the same dose, 
has also been recommended. These remedies may be re- 
peated as often as they may seem necessary. 

The treatment of the tumours requires judgement, skill, and, 
in some cases, intrepidity. Some of them are exceedingly vas- 
cular, and. produce, when removed, considerable hemorrhage. 
If they are small, they are removed without danger. If larger 
the hemorrhage will be greater ; and from those situated in- 
ternally, it is not easily controlled. Where danger from loss 
of blood is apprehended, a ligature should, if practicable, be 
resorted to. It is impossible to point out the cases in which 
it may be unsafe to resort to an operation. The relief afford- 
ed by the removal of these tumours, especially such as dis- 
charge great quantities of blood, is very great. They should 



INFLAMMATION OF THE BOWELS. 415 

be operated on when freest from irritation ; and with this pre- 
caution, I have never seen much inflammation ensue. In or- 
dinary cases, the operation is exceedingly easy, and is best 
performed with a pair of scissors. 



INFLAMMATION OF THE BOWELS— ENTERITIS. 

I propose to treat in this chapter, of inflammation of the 
small intestines, not as it appears in typhus fever, diarrhoea, or 
as a sequel of other diseases, but as an original disease. The 
symptoms which characterize this particular affection, are in 
many instances obscure ; and he is fortunate who, in attending 
to numerous cases, shall escape error. The most common 
mistake is, to consider this disease as an ordinary attack of 
colic ; and, the greatest danger, the administration of drastic 
cathartics for its relief. The mistake is too apt to be the re- 
sult of haste and inattention ; but its consequences are suffi- 
ciently grave, to admonish us to take great care in making our 
investigations of the diseases of the abdomen. 

CAUSES. 

Inflammation of the small intestines is, so far as I know, 
never epidemic ; but depending on causes applicable to the in- 
dividual who is attacked with it. The most common of these, 
is exposure to cold, especially standing on the cold ground, or 
in cold water. But the presence of foreign bodies, or of poi- 
sonous, or acid substances, in this portion of the intestines, are 
also causes ; and, within my observation, the most frequent. It 
is unnecessary to mention the substances which have been 
known to produce this disease. The preparations of arsenic, 
copper, and mercury, are the most frequent ; but when these 
and similar substances are the cause, the inflammation extends 
to the stomach also. The smallness of the tube in this portion 
of the bowels makes it a seat for the lodgement of foreign bod- 
ies, which may have been improperly or accidentally swallowed. 
I have known a quarter of a dollar, which had been swallow- 
ed by a child, produce for more than a year, more or less in- 
flammation in the small intestines; and it is stated, that it is in 
this portion of the bowels, concretions of chalk and other sub- 
stances have been found. 

Intussusception, or invagination of the bowels, happens only 



416 INFLAMMATION OF THE BOWELS. 

in this portion of the intestinal canal. This accident, which 
consists in the drawing of one portion of the intestine within 
another, as we frequently see a portion of the finger of a glove, 
produces violent inflammation. The portion thus invaginated 
is sometimes very small ; but in others, the process goes on till 
nine inches or more of the intestine, is thus drawn within it- 
self ; and, strange to tell, the portion thus drawn in and stran- 
gulated, sometimes sloughs off and comes away, and yet the 
patient recovers. 

DESCRIPTION. 

Inflammation of the bowels, like other inflammatory dis- 
eases, sometimes comes on with a chill; but, in cases in which 
its approach is gradual, the chilliness is either very slight or 
unnoticed. Pain in the bowels soon follows, and great tender- 
ness from the navel downwards, especially towards the right 
hip. The bowels are frequently costive ; but in other cases, 
very copious discharges take place. When the bowels are in- 
vaginated, or violent vomiting takes place, and frequently the 
feces or matter which should pass downwards, is thrown up. 
Fever, commonly attends the disease from the first. The pulse, 
as it commonly is, in diseases of the bowels, is quick, small, 
and hard, but soon gives way, becoming soft and rapid. The 
disease, from the first, is painful and alarming, and is in fact 
very dangerous. 

It is of some consequence to discriminate this disease from 
colic, which resembles it in so many respects. When it com- 
mences "with distinct rigor, and is attended by thirst, a hot 
skin, and a hard frequent pulse?" Dr. Watson thinks, "there 
is no room for doubt." I should rely myself on the tenderness 
from pressure, and the violence of the fever attending this dis- 
ease. If a violent distension of the bowels, with great increase 
of tenderness, takes place, there can be no impropriety in treat- 
ing it as enteritis. 

TREATMENT. 

The general remedies for inflammation, require some modi- 
fication in their application to inflammation of the bowels. 
We shall explain this as we proceed. 

Bloodletting, — This powerful remedy for inflammation, will 
of course find a place at the head of our list of remedies. It 
should be adopted as early as the nature of the disease can be 
ascertained. If the disease has not existed more than a day 
or two, the smallness and rapidity of the pulse should not too 



INFLAMMATION OF THE BOWELS. 



417 



soon deter us from the use of the lancet. Experience seems, 
however, to sanction the belief, that in this disease, though an 
acute inflammation, we cannot persist in bloodletting to the ex- 
tent it might be beneficially carried in some other diseases. If 
the pulse is not made slower, and the pain greatly relieved b} r 
bloodletting, I should not repeat the remedy. 

Leeching and cupping. — These remedies are a means of draw- 
ing blood on a smaller scale, from vessels nearer the affected part. 
There can be no doubt of their great utility in this disease, 
and of their being proper in cases where the exhaustion is too 
great to allow of general bleeding. I can see no preference of 
one of these remedies over the other, except what arises from 
the degree of pain attending the operation. The application 
should be as near the seat of pain as convenient, and the quan- 
tity of blood thus drawn regulated by the strength of the pa- 
tient. 

External application of cold. — For what reason warm fomen- 
tations to the abdomen, have been generally recommended in 
enteritis, I am unable to divine. That they should do good in 
common colic, when there is great pain and cramp, or spasm 
of the bowels, is reasonable enough ; but when there is pres- 
ent an acute inflammation of the intestines, I must think the 
application of cold by far the better remedy. This has ot 
late years been my practice. I have, without hesitation, 
applied cold by wet towels, or ice, if to be procured, in all 
cases of inflammation of the bowels, whether complicated 
with inflammation of the peritonaeum or not. I have thought 
these applications as beneficial here, as in other inflamma- 
tions ; and I do not hesitate to recommend them to all who 
have occasion to prescribe in this disease. Perhaps at an ear- 
lier time than in other inflammations, we may be admonished 
by cold extremities, to abandon the use of cold applications ; 
but for the same reasons which demand the use of leeches, 
under these circumstances, the cold applications should be con- 
tinued longer, than the state of the system generally would seem 
to warrant. To me, it seems inconsistent to apply warm fomen- 
tations after leeches. But aside from sll reasons of this kind, 
I confidently recommend the cold applications as the result of 
experience. I have, again and again, tried them, and found, 
under their use, the extremities grow warm, the heat of the 
body become less, the pulse slower, and all the symptoms of 
an equalised excitement and great improvement, follow. 

Blisters. — It is in the latter stage of this disease that blisters 
should be applied. It is only when the skin becomes moist, 
27 



418 INFLAMMATION OF THE BOWELS. 

that a blister can fill with a fluid serum, and continue to dis- 
charge freely for several days. It is only in such cases that 
they are beneficial ; but if they are applied too early, and fill 
with a gelatinous fluid, which will not flow out when the skin 
is opened with a pair of scissors, they immediately dry up, and 
do very little good. 

Internal remedies. — Great judgement, and much knowledge 
of the power of medicines, are necessary in directing their in- 
ternal exhibition, in cases of inflammation of the bowels. In 
most, cases, the stomach ejects almost every thing taken into it ; 
in others, there is invagination, or other obstruction to the pas- 
sage of any thing through the bowels ; and, in all, a tenderness 
of the intestines, calling for the least disturbance and most rest. 
These circumstances seem to forbid the use of emetic or ca- 
thartic medicines, and authorities concur in dispensing with 
them, in a very great degree. 

Calomel and Opium. — In spite of the valid reasons against the 
liberal use of cathartic medicines in this disease, this combina- 
tion has met with very general sanction. It is to be given at 
first in a liberal dose, say three grains of opium, and twenty of 
calomel, made into pills and taken at once. If they are thrown 
up, (and care should be taken to ascertain the fact,) let them 
be immediately repeated. This is, I have no doubt, the most 
valuable internal remedy, yet discovered for this disease. In 
extreme cases, it may be repeated in twelve hours ; but this 
will be seldom necessary. The calomel and opium thus com- 
bined, perform two great purposes, the relief of pain, and the 
gradual movement of the bowels. But there is great reason 
for thinking that the calomel, besides its purgative qualities, 
operates, in this case, with a mildness and efficiency not found 
in any other remedy. 

Should the case prove obstinate, as all those depending on 
obstruction of the bowels are likely to do, a judicious use of 
calomel and opium is still the main reliance. A deep saliva- 
tion is to be avoided by not repeating the calomel more • than 
once, before satisfactory discharges from the bowels are brought 
on. This is to be effected by small, repeated doses of mild 
purgatives, such as castor oil ; and if it fails, senna and salts. 
The opium is to be given, with care not to increase the irrita- 
tion and fever attending the disease. This is best accomplish- 
ed by giving it in large doses, at long intervals. Three or four 
grains of opium, or sixty, or eighty drops of laudanum, once 
In twenty -four hours, if the pain is intolerable, or the strength 



DISEASES OF THE ABDOMEN. 419 

of the patient seems to be giving way, will be a good rule for 
its administration. 

These remedies are proper in the first or inflammatory stage ; 
but in protracted cases, this more than other inflammations, 
seems to prostrate the patient, and require the use of stimu- 
lants and nutritious diet, towards its close. This is probably 
more the case where the bowels have been obstructed, and es- 
pecially when sloughing of the intestine happens. This last 
case can be considered only as a case of mortification, and is 
to be treated accordingly. The stimulants to be used in these 
cases, are spirit, wine, laudanum, quinine &c. The quantities 
used should correspond with the strength of the patient, or 
rather with his weakness, the larger quantity being requisite 
where the weakness is greatest. 



DISEASES OF THE ABDOMEN. 

The organs contained within the abdomen are not vital in 
the same degree, with the brain, the lungs, or the heart ; they 
are, however, subject to many and fatal diseases. It is, there- 
fore, important, that in the study of the diseases that affect 
these organs, our examinations should be conducted on proper 
principles. 

A perfect knowledge of the state and situation of organs 
concealed from our sight, as those of the abdomen are, cannot 
be obtained ; yet a great deal may be learned by a judicious 
investigation of the subject. When, from the symptoms of a 
disease, it is suspected that it has its seat in the abdomen, it 
should be examined with due care. A general knowledge of 
the position of the organs it contains, should be had; and it 
should be also known, that these organs are so loosely attach- 
ed to their position, that they maybe removed to some distance 
from it. The seat of disease is sometimes manifested by pain; 
in other instances, swelling, or enlargement becomes manifest; 
guided by these, a near approach to the knowledge of the seat 
of disease in the abdominal cavity, may be obtained. 

To make these investigations satisfactory, the patient should 
be placed in a horizontal position, on his back, with his head 
well raised, and knees drawn up. The walls of the abdomen 
are thus relaxed, and the organs situated within them easily 
examined. The principal derangements which are made mani- 
fest by this examination, affect the liver, the spleen, the stom- 



420 DISEASES OF THE ABDOMEN. 

ach, and parts of the intestinal canal. An enlarged liver is 
easily felt, passing out from under the ribs on the right side ; 
its volume is often so great, that it descends far down the side, 
even with, or below the hip. From nearly the same position 
on the left side, the spleen often projects, extending across the 
abdomen, manifesting considerable hardness, and a bold, well 
defined margin. The womb, after child birth, and the blad- 
der, when distended, occupy the centre and lowest part of the 
abdomen, and are, in this state, frequently manifest to the 
touch. The intestinal canal is less frequently subject to dis- 
orders, which manifest themselves by enlargements that may 
be felt. To this, however, there are exceptions. The colon, 
or large intestine, is sometimes vastly distended with matters 
which should have been ejected. I have felt in a living child, 
three or four years old, the arch of the colon, passing across 
the abdomen like an enormous sausage, which was proved after 
death, to have been caused by more than a pound of worms, 
tangled together in that intestine. This intestine is the seat of 
many painful disorders, especially colic, which takes its name 
from it. It arises near the right hip, and passes up towards 
the pit of the stomach, where it passes across, and down by 
the other side. The small intestines occupy the central posi- 
tion in the abdomen, from the stomach downwards ; and the 
stomach itself, which is a comparatively small organ when not 
distended, occupies a central position at the joining of the 
ribs from each side. Where the patient is not very corpu- 
lent, these organs, when in a state of disease, may be gen- 
erally investigated in a satisfactory way ; and when, from 
a continuance of disease, great emaciation has taken place, 
these examinations become much more perfect. Fluids con- 
tained within the abdomen, and exterior to the intestinal canal, 
are easily detected. By placing the hand on one side, and 
giving on the other a light tap with the finger of the other hand, 
a sudden impulse of the fluid will be felt, which can not be 
easily mistaken. If the fluid contained is small in quantity, it 
will be found in the most dependent position. If the patient 
turns from one side to the other, it will be heard running down 
gurgling amongst the bowels, till it has reached the lowest 
point. This will be manifest if the ear is placed in contact, or 
nearly in contact with the walls of the abdomen. In doubtful 
cases, percussion may be made on this portion of fluid, which 
has thus reached the lowest point, by placing one hand under 
it, and striking with the other, at an inconsiderable distance 
from it. I have found this as satisfactory, and the manifesta- 



INFLAMMATION OF THE PERITONAEUM. 421 

tion of the presence of fluid as clear, as when the distension 
of the abdomen was very great. 

By these simple means, the organs contained within the cavi- 
ty ot' the abdomen, are made to manifest their diseased condi- 
tions. Pain is by no means so sure a test of the presence of 
disease, as the enlargements of which we have spoken ; for, 
in many instances, there is either no pain, or the pain felt is at 
a distant point from the disease. This, however, is not so fre- 
quently the case, as to warrant us in overlooking the exact po- 
sition of pain or tenderness on pressure ; they are generally 
manifestations of the presence of disease. 



INFLAMMATION OF THE PERITONAEUM— PERITO- 
NITIS. 

The lining membrane of the abdominal cavity, is called se- 
rous, from having, in health, a sufficient portion of serum on 
its surface to prevent adhesion, and to facilitate the motions of 
the organs contained within it. Like other membranes of this 
kind, the peritonaeum is subject to inflammation ; and when in- 
flamed in any part, that inflammation is disposed to spread 
throughout its whole extent. The disease, in this way, be- 
comes formidable- — tending to speedy death ; or, in the event 
that such a result is averted, adhesion, dropsy, or other disor- 
ders too often follow. 

The causes of this disease are similar to those producing in- 
flammatory diseases in general; great exposure to wet and 
cold, being the most prominent. But it is not to be forgotten, 
that this disease sometimes seems to arise from a general or 
epidemic cause, independant of the sensible qualities of the 
air. Thus it will sometimes happen, that many cases will oc- 
cur from slight injuries, and some without any visible cause, 
about the same period of time ; when, at other times, a physi- 
cian in full practice may pass several years without witnessing 
the disease in a single instance. Women in child-bed are 
particularly subject to its attacks, in the most awful form ; and 
this I have noticed to occur in the manner of which I have been 
speaking. In Europe, in the lying-in hospitals, a strong sus- 
picion has arisen, that the disease is contagious, and that the 
midwife or the nurse that has attended to one, suffering under 
this disease, may propagate it, by attending on others, under 
like circumstances. I have never seen any thing which would 



422 INFLAMMATION OF THE PERITONAEUM. 

warrant me in countenancing such a suspicion. Yet the fact, 
if it be true, is too important to be overlooked by those to 
whom the important charge of nursing lying-in females, is en- 
trusted. 

SYMPTOMS. 

Acute inflammation of the peritonaeum , is known by extreme 
pain and tenderness of the abdomen, not in particular organs, 
but increased by coughing, sitting up, or other movements 
tending to give pressure to the parts. There is considerable 
fever, but the pulse is subject to great variety, sometimes full 
and strong, at others sharp, small, wiry, rapid. The patient 
lies on the back, with knees drawn up, breathing quick and 
short, and apparently using the ribs only in this process ; thus 
instinctively protecting the parts below, from the pressure of 
the descending diaphragm. The abdomen is swollen from the 
first, but becomes tense from wind, and is tender to an extreme 
degree ; so much so, that even the weight of ordinary bed 
clothing is complained of. This tenderness is so great, that 
the physician in his examination ought to use extreme care in 
touching or handling the abdomen. The pain, although never 
absent, becomes by turns extreme ; and the slightest motion, 
even the passage of air from one portion of the intestines to 
another, is attended with aggravation of the symptoms. The 
countenance will be readily noticed as indicating the deepest 
misery. As the case progresses to a fatal termination,, it be- 
comes ghastly and shrunken ; cold sweats, and breathing more 
and more impeded, closing the scene. But even to the end, 
there is a calmness in the mind, and an absence of delirium, 
which is very striking. 

Other symptoms might be mentioned, but they are not so 
frequently present — such as vomiting, strangury, or suppres- 
sion of urine. Perforation of the stomach or intestines by ul- 
ceration or accident, so that their contents flow out into the 
abdominal cavity, produces perhaps the most sudden and fatal 
attacks of this disorder. A rupture of the bladder or uterus 
will produce the same efFecL 

So striking and peculiar are the features of this disease, that 
it will be readily discriminated from others ; but we are charg- 
ed by Doctor Watson against mistaking certain attacks of 
hysteria, for inflammation of the peritonaeum. I remember a 
single instance only, in which I, for a very short time, was under 
this misapprehension. The mistake, if made, will be of no 
fatal consequence ; but, with some attention to the collateral 



INFLAMMATION OF THE PERITONAEUM. 423 

circumstances of the case — the age and previous health of the 
patient — degree of exposure — mental excitement, and espe- 
cially inordinate fear, we shall not be in much danger of ma- 
kin q; such a blunder. 

TREATMENT. 

Inflammation of the peritonaeum is a dangerous, and often a 
fatal disease ; it is to be treated, as the highest degree of in- 
flammation, with such variations as the cause and character of 
the case may demand. Our great reliance is on bloodletting, 
and mercury — calomel. Bloodletting should be practiced ear- 
ly ; for so rapid is the progress of this disorder, that the time 
at which it may be beneficial, has frequently passed in a single 
day. The pulse, our great guide in the use of this remedy, is 
less to be relied on here than in other cases. If the patient 
is in an ordinarily full habit, and not prostrated by previous 
disease, the smallness of the pulse, unless it be also soft, should 
not deter us from bleeding. If the remedy is doubtful, it is 
prudent to draw, at first, only a small portion of blood. If it 
is beneficial, the pulse will speedily become slower and fuller : 
in which case, the arm may be again corded, and an addition- 
al portion of blood drawn. This precaution should not be re- 
garded slightly, for it is to be remembered, that in this, as well 
as in other inflammatory diseases, there occur cases of such 
malignity, that, from the first, the abstraction of blood, and 
other depleting remedies are wholly inadmissible. Local 
bleeding is highly recommended in these cases. Writers say, 
cover the abdomen with leeches. My own opinion is, that this 
mode of abstracting blood is not entitled to a great deal of 
preference, over bloodletting at the arm. Should the case con- 
tinue, and inflammatory symptoms still remain, the bleeding 
may be repeated, after twelve or twenty-four hours ; but I am 
no advocate for the heroic plan of letting the blood flow till the 
patient sinks under it, to fainting. The great object of the 
practitioner, according to our most approved authorities, is to 
bring on salivation. For this purpose, calomel, in doses of 
four or five grains, should be given every six hours ; and we 
are advised to hinder their passing off by the bowels, by the 
occasional administration of morphine or laudanum. This, 1 
have no doubt, is good practice, in cases which are running out 
to a chronic state ; but, in the first days of an acute disease of 
this kind, I think this practice extremely faulty. I do not ob- 
ject to salivation. That is an event which may, in some cases, 
be desirable ; but we are not to make it so great an object, as 



424 INFLAMMATION OF THE PERITONEUM. 

to hinder us from combating with oar most potent remedies, 
the intense inflammation of the first two or three days. 

Cathartics are a much disputed remedy in this disease. The 
great pain which attends the slightest movement, even the 
passage of wind through the intestines, is thought to be evi- 
dence of the danger of using active cathartics, which give to 
the intestines so great an increase of motion. My own opinion 
is, that this is an error. There is no case in which I would ex- 
press an opinion with more diffidence, than in this. My expe- 
rience in it has not been great, and that which I have had, has 
been principally in lying-in women ; but in these cases, and 
indeed in all cases of the acute kind, where there was no dis- 
organization of the parts to apprehend, I should think my pa- 
tient deeply injured by withholding from her the use of cathar- 
tics. In cases occurring in child-bed women, I have tested 
their value to my entire satisfaction. The cathartic I use al- 
most exclusively, is composed of calomel and gamboge. Take 
twenty grains of calomel, and eight grains of gamboge, form it 
into eight pills, and administer four of them. Of the remaining 
four, give two every four hours, till they operate as a cathar- 
tic. Should all fail to move the bowels, castor oil should be 
taken in broken doses, till a full cathartic effect is produced. — 
Remember, a full cathartic effect — several copious discharges 
are necessary. If, after copious discharges have taken place, 
there should be great pain, I advise the use of half a grain of 
morphine or forty drops of laudanum. If the prostration of 
the patient is great, these doses may be doubled ; but I must 
say, that in the child-bed cases, which I have met with, this 
use of the laudanum has been seldom necessary ; the copious 
discharges brought on by the cathartic remedies, have, in al- 
most every case, been attended with such manifest and great 
relief from pain, that the opium has not appeared to be neces- 
sary. Under this treatment, salivation seldom occurs, and I 
think it as seldom necessary. 

External applications to the region of the abdomen, are a 
^matter of equal dispute with cathartics. While you are recom- 
mended by one, to make use of warm poultices, renewed from 
time to time, another will advise you to apply bladders filled 
with pounded ice. My own practice has been, to make use of 
the warm applications. They are certainly in some cases, at- 
tended with great relief from pain, and have not, as far as I 
know, been productive of any injury. Wheie the case has 
continued for three days or more, I have been well pleased 






INFLAMMATION OF THE PERITONAEUM. 42-5 

with the effect of extensive blistering, and do not now hesitate 
to recommend it. 

In cases arising from the presence of foreign matter which 
has escaped from the bowels, the bladder, or other source; 
the physician has nothing to rely on, and the patient nothing 
to hope. They are almost always fatal. Opium, repeated 
from time to time, according to the urgency of the symptoms, 
forms our best reliance, and it is pleasing to know, that this 
remedy is equally entitled to the first place, in reference to both 
the comfort and safety of the patient. For the quiet and re- 
pose which it gives to the intestines, affords the best opportu- 
nity to nature for a repair of the injury which has been done. 
The few cures which are said to have been made, have been 
attributed to this remedy alone. 

Few diseases require a more discriminating judgment in the 
practitioner than this. I have recommended, in conformity 
with the experience I have had, strong and powerful depleting 
remedies. I have, at the same time, recommended the warm 
applications and blistering, which I have seen condemned by 
some. I am not prepared to dispute the benefits which others 
have derived from the use of cold, instead of warm applica- 
tions ; or the ill effects they may have seen from the use of ca- 
thartics. I can easily credit the great malignity which the 
disease has sometimes put on, forbidding entirely the course I 
have recommended, and compelling a reliance on the opposite 
course ; with the use of opium, quinine, and brandy. But I 
repeat again, I have not met with such cases ; and that with the 
treatment I have recommended, I have had the greatest reason 
to be fully satisfied. 

CHRONIC INFLAMMATION OF THE PERITONAEUM. 

Persons who escape from a speedy death, under attacks of 
inflammation of the peritonaeum, are frequently only reserved 
for the same fate, by a lingering process, from a chronic inflam- 
mation of the same membrane. They in fact do but partially 
recover ; and a lower grade of inflammation remains. This 
low chronic form of disease, does not always arise from the 
acute form. In many cases it makes its insidious and dange- 
rous progress at first almost unperceived. 

The symptoms which attend this disease, are slight pain in 
the region of the abdomen, nausea, disordered bowels, tender- 
ness to the touch, some enlargement or swelling of the abdo- 
men, and a continued low inflammatory fever. In many instan- 



426 DROPSY OF THE ABDOxMEN. 

ces, it arises from disorders of particular organs. The omen- 
tum especially, is sometimes found in a peculiar state of dis- 
ease, the character of which is not very well understood. It 
seldom arises from the disease of the liver and spleen. When 
it succeeds the acute inflammation, it is frequently found at- 
tended with adhesion of the parts of the cavity which had been 
most affected by the disease. 

TREATMENT. 

Too often this disorder, although not formidable in its ap- 
pearance, is founded on incurable mischiefs ; and our remedies 
are at best, but palliative. There is, however, no great diffi- 
culty in pointing out the means, which may be used, with most 
benefit. Bleeding often repeated, in small quantities at a time, 
is, I have no doubt, the most valuable remedy we possess. 
Leeches would seem to be our best means of abstracting blood, 
in these cases ; cupping is wholly inadmissible, on account of 
the tenderness of the parts. Beyond this, I should advise, 
from time to time, such mild cathartics as might hinder the 
accumulation of improper matters in the intestinal canal. If 
the pulse were strong and corded, I should not hesitate to use 
the antimonial mixture, repeated several times through the 
da} r , in such doses as the stomach might bear without indu- 
cing vomiting. These and other remedies, which the particu- 
lar symptoms of the case may seem to call for, may in some 
cases lead to a cure ; but it is not often, that we should flatter 
ourselves with the expectation of so favorable a result. 



DROPSY OF THE ABDOMEN— ASCITES. 

This disease frequently arises from chronic inflammation of 
the peritonaeum, and is, in that case, an effusion of serum from 
an inflamed surface. When the inflammation which has given 
rise to it, has been produced by cold, or other temporary cause, 
the disease is frequently curable ; but, like other dropsies, it 
frequently arises from causes entirely beyond the reach of our 
means of cure. 

We have alluded to cold, or an ordinary inflammation from 
this cause, as a frequent cause of dropsy of the abdomen. The 
other causes may be briefly summed up in circumstances pro- 
ducing a single effect — the hindrance of the return of the ve- 



DROPSY OF THE ABDOMEX. 427 

nous blood, from the organs contained within this cavity. 
When the blood which is distributed to the liver, for instance, 
finds in consequence of the vessels through which it should be 
returned being obstructed, great hindrance to its passage, a 
transudation of the watery portion of the blood, through the 
coats of these vessels, takes place ; and this forms the most 
common source of the fluids, found in the abdomen in this dis- 
ease. Great variety, however, has been found in this fluid : in 
some instances, it is deeply colored, as if mixed with blood ; in 
others, gelatinous — so thick as not to flow through the trocar, 
introduced for the purpose of its discharge. This I witnessed 
in the Pennsylvania hospital. Doctor Physick performed the 
operation of tapping ; but not a drop of any fluid made its ap- 
pearance. He gave the opinion that the matter contained was 
a thick jelly, and that the case might be considered hopeless. 
This species of dropsy occurs also when there is a general drop- 
sv ; and it may arise from the same cause which has pro- 
duced the dropsy, in other parts of the body. 

Ovarian dropsy, will of course find its place in the abdomen, 
but is to be discriminated from the general dropsy of that cavi- 
ty. The ovaries, it will be recollected are small bodies, placed 
on each side near the hip ; a very small vesicle, forming in one 
of these, sometimes takes on an enormous growth, filling the 
whole cavity of the abdomen, with a great sack, of considera- 
ble thickness and strength. The disease is commonly first no- 
ticed in the form of a small tumour, occuring in the lower part 
of the abdomen, near one side. By degrees it increases in size, 
producing a manifest fulness of one side more than the other. 
In this state it may be examined, and by percussion, a light tap 
with one hand, the opposite side from which the other is ap- 
plied, will be distinctly felt to contain fluid. It will be known 
from abscesses, by the absence of pain and soreness. These 
cases of dropsy are commonly those which have given rise to 
the numerous tappings of the same individual, which we read 
of. The sack seems to admit of indefinite growth and disten- 
sion ; and the amount of fluid discharged in these cases is fully 
as great, as in other forms of this disease. 

Other forms of encysted dropsy of the abdomen, have been 
mentioned ; but they are of rare occurrence, and, in almost 
every case, arise from incurable disorders. 

TREATMENT. 

It is manifest that in treating of dropsy of the abdomen, 
great attention should be bestowed on its remote causes. 



42S DROPSY OF THE AEDOMEN. 

When these can be removed, our hopes of success are very 
great. If it be a liver disease, or disease of the spleen, our 
remedies should be directed to the removal of those diseases, 
of which I shall treat under their proper heads. Still, the or- 
dinary remedies for dropsy should be used. Active cathartics 
are especially applicable ; of which the best with which I am 
acquainted, is cream of tartar and jalap. It should be given to 
operate actively, twice a week, or oftener, if the patient's 
strength seems to admit of it. Mercury is a standing remedy 
in this disease. Calomel should be given, four or five grains a 
day, for many days in succession, after the use of the more ac- 
tive cathartics we have mentioned. If salivation comes on, it 
will be all the better. Diuretics, or remedies promoting the 
discharge of urine, are also proper here ; and squills are per- 
haps the best of these. This article may be given separately, 
or combined with calomel. My preferences are for its combi- 
nation with calomel. Pills containing one grain of calomel, 
and two or three of squills, may be given three or four times a 
day. In addition to these remedies, when the case becomes 
protracted, I advise the use of the antimonial mixture', given 
in such doses, and at such intervals, as the patient may conve- 
niently bear. Iodine, especially the hydriodate of potash, has 
been highly recommended in these cases. I have no experi- 
ence of its use, but should resort to it with some hopes, where 
the liver and spleen were particularly implicated. 

Where these remedies fail, and the case becomes intolerable 
from the distension which attends it, where, indeed, a speedy 
death seems to be impending, I advise the drawing off of the 
fluid by tapping. This remedy has not a great deal of reputa- 
tion in the treatment of dropsy ; for it is but too common for the 
fluid to accumulate again, with greater rapidity than before. 
Still it gives some hope of a permanent cure, and almost always 
great relief from present suffering. The relief obtained is 
sometimes very great indeed. When a very young practition- 
er, I performed this operation on a very poor woman, who was 
unable to rise from her bed ; breathed with the greatest difficul- 
ty, and had not, to all appearance, a day to live. Having 
drawn from her some three gallons of fluid, and placed around 
her a supporting bandage, I left her ; but great was my sur- 
prise, when on returning the next/'morning, I found her out be- 
fore the door sweeping the yard. I could hardly realise the 
idea, that she was to live but a few days. The operation of 
tapping, although very simple, is of too grave a character, to be 
entrusted to common hands. A surgeon of some skill should 



HEMORRHAGE FROM THE STOMACH. 429 

by all means be employed ; and even to such a one, I suggest 
the great importance of properly supporting the abdomen with 
proper bandages, during, and after, the discharge of the con- 
tained fluid. 



HEMORRHAGE FROM THE STOMACH— VOMITING 

OF BLOOD. 

This is always an alarming — frequently, a dangerous dis- 
ease. The blood is not seen till a considerable quantity has ac- 
cumulated in the stomach, when it operates as an emetic, and 
is thrown up. It is commonly very much darkened in its color, 
and thrown up in clots or lumps. Sometimes it originates from 
certain diseases of the stomach, which open considerable ves- 
sels by ulceration ; but more commonly it seems to arise from 
blood which oozes from the minute vessels, of more or less of 
the internal surface of the stomach. The exact source of blood 
in such cases, it is not in our power to divine. It may be 
thrown into the stomach, from some point of the alimentary ca- 
nal, either above or below. The disease, except when it arises 
from incurable maladies, is not so fraught with danger as it 
might appear. , The distension of vessels which give rise to 
it, is relieved by the discharge, which, from that cause alone, 
will commonly cease. In many instances, it seems to be a 
substitute for other discharges, whether those discharges are 
from diseased organs, or from natural evacuations. The least 
dangerous of its forms, is that which occurs from suppressed 
menstruation. The stomach appearing, in such cases, to per- 
form the office of the uterus ; from month to month, for an in- 
definite time. Such cases have been known to continue for 
many years, without any apparent injury to health. 

CAUSES. 

We have already suggested, that deranged menstruation, 
cancerous ulcers, and certain suppressed discharges, may give 
rise to vomiting blood. Other causes, however, not unfrequent- 
ly give rise to this disease. Injuries of the stomach, from falls, 
blows, or similar accidents, as well as the introduction of im- 
proper matters, poisons, for example, into the stomach, may 
also give rise to this discharge. But with the exception of 
suppressed catamenia, which is by far the most common cause 
of vomiting blood, the disorders of the liver and spleen, proba- 



430 HEMORRHAGE FROM THE STOMACH. 

oly produce it most frequently. We are taught by anatomy, 
that the blood thrown into this organ by its arteries, passes 
back on its way to the heart through the liver. The obstruc- 
tion it here meets with, in passing through the diseased organ, 
will, in many instances, cause a bursting forth of the blood 
from the minute vessels of the stomach, which are thus unable 
to propel it forward. An enlarged spleen or pancreas may 
produce a similar obstruction. A mechanical impediment, by 
pressure on these veins, may produce the same effect. I have 
no doubt the diseases attendant on these enlargements of the 
viscera, produce a thinness of the blood, which favors the dis- 
charge in question. In several diseases, especially scurvy, 
this discharge of blood from the stomach is not uncommon, and 
it has been long noticed as a symptom of fever. I have often 
witnessed it in the autumnal fevers of this region, and have 
seen it in a few instances in those which were deeply typhus. 
A very slight disorder of this kind is frequently met with, 
from the over action of an emetic. Small quantities of blood 
discharged by vomiting, will sometimes be seen ; but I have 
never known such a hemorrhage, to produce any ill conse- 
quence. In dyspepsia also, when the stomach is overcharged 
with acid, especially in pregnant women, more or less blood is 
frequently discharged by vomiting. 

symptoms. 

It would appear, that nothing could be plainer than the fact, 
that a patient threw up blood by vomiting ; yet it is not always 
easy to know certainly that the blood thus shown, has come 
from the stomach ; and there is still greater difficulty in show- 
ing that the blood which is thrown up, has originated from that 
organ. Many causes tend to produce this obscurity. Blood 
thrown into the throat from any disorder, is frequently swal- 
lowed without the consciousness of the patient ; it is sometimes 
coughed up from the lungs, and then swallowed ; and it may 
flow along the intestinal canal from distant points to the stom- 
ach, preparatory to its discharge by vomiting. It may be ad- 
ded, that cases have occurred in which fraudulent attempts to 
prove the presence of this disease, by crafty, wicked, or in- 
sane persons, have been met with. Blood obtained from other 
sources, has even been secretly swallowed, that it might be 
thrown up in the presence of witnesses. 

The symptoms, which ordinarily attend the vomiting of 
blood, are a sense of weight in the stomach, paleness of the 






HEMORRHAGE FROM THE STOMACH. 431 

face, griping pains in the bowels, and sometimes fainting. 
Vomiting speedily follows. Blood, sometimes a pint or more, 
is discharged at once, and frequently at no great length of time, 
a similar discharge takes place by stool. If the blood has 
originated in the stomach, the clots into which it will be form- 
ed, will be larger and less broken. If it has been swallowed 
from the throat, or has made its way from a distant point in the 
intestinal canal, by a retrograde movement from below, it will 
be broken up, and, if clotted, will be found in small pieces. 

TREATMENT. 

Blood, when thrown into the stomach in sufficient quantity, 
is an emetic ; thus securing its own prompt discharge. When 
it passes into the bowels, it is a cathartic ; and here, unless 
the quantity is small, its discharge is speedily brought about. 
No remedy, therefore, is requisite to promote the discharge of 
the blood from the stomach. An opinion must first be formed 
of the cause of the hemorrhage ; if it has arisen from suppres- 
sed menstruation, no very active treatment will be demanded ; 
probably the discharge of blood has ceased, even before its 
presence is manifested by vomiting. In some of these cases, 
however, the quantity of blood discharged, is very considera- 
ble. It is thought, chat it seldom or never endangers life ; and 
recoveries from it are remarkably prompt. If from the excess 
of the discharge, it seems desirable to limit its quantity, the pa- 
tient should be kept perfectly still, and exposed to cold air. I 
have never found it necessary, in such cases, to do any thing 
more at that particular moment. 

When the discharge of blood has arisen from other causes, 
we are to direct our remedies accordingly. A discharge of 
dark blood, scarcely clotted, vomited up in some quantity, but 
passed in far greater quantity from the bowels, sometimes 
takes place. It is thought to originate from the liver, and to 
pass through the gall-duct into the bowels. This form of the 
disease, we are advised to treat with strong cathartics ; and 
we are told to look with great confidence for a successful re- 
sult. These cases are not very frequent. When they occur 
as a critical discharge from a diseased organ, I have no doubt 
a cure will take place under brisk and powerful cathartics, or 
under mild ones. Nature has indeed taken the cure on her- 
self. But the diseases of the liver are so frequent and various, 
and these internal discharges of blood so often vicarious, that 
is, the discharge is for the relief of a distant organ, that I think 



432 HEMORRHAGE FROM THE STOMACH. 

the physician may well look with great anxiety to the result in 
cases of this kind. As a general rule, I think cathartics should 
be administered very sparingly, in this disease. The presence 
of clots of blood, at the source from which it flows, must needs 
give some pressure towards the closing of the bleeding vessels. 
And, as I have remarked above, when blood accumulates in 
quantity, it is itself a cathartic, and promotes its own dis- 
charge. 

Blood letting, leeching, and blistering, are mentioned as 
remedies for this disease. The first of these remedies, could 
it be adopted in the outset, would, I have no doubt, often sup- 
press the discharge very promptly. But to me it appears not 
to be a very valuable remedy ; for the occasion for its use will 
generally have passed before the physician has an opportunity 
to try it. It should not be used after the discharge of blood has 
been considerable. Leeches and blisters I have never used ; 
but in chronic cases, I should think they might be profitably 
employed. 

Cold applications, especially the introduction of cold water, 
iced water, or even bits of ice into the stomach, suggest them- 
selves as valuable remedies in this disease ; and when it is 
considered, that there is frequently present a strong inflam- 
matory action, which, as long as it continues, renders ques- 
tionable, or forbids the use of strong astringent remedies ; it 
will be obvious that cold, used in this way, should be one of 
our most potent remedies. Experience justifies this opinion ; 
and, unless it is contra-indicated by manifest prostration and 
dangerous debility, I think that the application of cold in this 
way, ought by no means to be neglected. 

The internal use of astringents has been more disputed. My 
opinion is, that they cannot be safely dispensed with, where 
the disease does not speedily yield to other remedies. In this 
country the acetate, or common sugar of lead, is regarded with 
more favor than any other remedy of this class. Five grains 
of it may be given, hourly, for five or six hours, should it ap- 
pear necessary. It has not yet occurred to me, to see this 
hemorrhage continue after the use of the third dose. Nor does 
it so much matter what may have been the cause of the hem- 
orrhage ; the remedy is equally applicable to cases which arise 
from the rupture of blood vessels by ulceration, or other cause ; 
or those which arise spontaneously, or from the numerous cau- 
ses which have been suggested. Opium should be combined 
with this remedy, except when there are present a high fever 
and bounding pulse. It is most conveniently given in the form 



FOREIGN BODIES IN THE INTESTINAL CANAL. 433 

of laudanum — from twenty to thirty drops may be administered 
with each dose of the sugar of lead. In extreme cases, where 
the powers of life seem nearly extinct, where the extremities 
have become cold, and the pulse exceedingly low. our reliance 
is principally on opium. From half a grain to a grain of mor- 
phine, or from thirty to sixty drops of laudanum, may be ad- 
ministered, followed by such cautious use of other stimulants, 
as the case may seem to admit. 

A very long list of other astringents, vegetable and mineral, 
might here be mentioned. 1 doubt whether a single one of 
them has much more virtue than the rest. Powdered galls, 
gum kino, and catechu, are the most worthy of reliance. They 
are particularly applicable to cases which continue for a length 
of time. In their power of suppressing hemorrhage, they are 
in no degree to be compared with sugar of lead ; but when the 
loss of blood is not great, and continues for a length of time, 
they are considered safer, and I should think it well to resort to 
them. Five or ten grains in powder of either of these articles, 
may be given, from one to three or four times a day. Tinc- 
tures from these articles may be substituted ; twenty to thirty 
drops at a dose. These substances are not to be used to the 
exclusion of opium, but combined with it — the opium or lauda- 
num being the more necessary, as the patient may be more ex- 
hausted and prostrated. 



FOREIGN BODIES IN THE INTESTINAL CANAL. 

It is not unfrequent, in horses and cattle, to find large con- 
cretions of solid earthy matter in the intestines. The bezoar, 
long regarded as a remedy for several incurable diseases, is 
found in the deer ; and I have a beautiful specimen of a stone 
of this kind lately sent me by a friend. I have never met with 
any thing of this kind in the human body, but have no doubt it 
is of frequent occurrence in other countries, and the size and 
weight which are reported of such concretions, are truly aston- 
ishing. Authors state, that they become sometimes so large as 
to be easily felt through the walls of the abdomen ; but in most 
instances, their existence has not been suspected, till their 
presence was made manifest by the dissection of the dead 
body. 

I should not have written a chapter on this subject, but that 
substances which pass by swallowing into the stomach, some- 
28 



434 FOREIGN BODIES IN THE INTESTINAL CANAL. 

times by accident, and sometimes by design, become, in some 
instances, a just cause of alarm. Children are frequently 
known to swallow pins, needles, buttons, small coins, and 
other things of this description. They are seldom productive 
of any inconvenience. T have never known any injury to fol- 
low the swallowing of pins ; needles I have known to pass out 
of the bowels into the flesh, and finally to make their appear- 
ance near the surface, and be removed. I have taken from 
the thigh of a child, three or four years old, a large sewing nee- 
dle which it had swallowed several months before ; and it had 
been productive of a great deal of pain, imperfectly described 
by the little sufferer, during its passage to the place, from 
which it was finally taken. 

It is surprising to see with what toleration the stomach bears 
even the roughest materials, thrown into it in this way. An 
insane man has been known to live for months with a stick, 
several inches in length, which he had forced or swallowed in- 
to his stomach. In another case of unaccountable simplicity, 
a man swallowed a pocket knife, and was induced to swallow 
several others from time to time, till he had swallowed twelve 
or thirteen. He lived in this condition a considerable time, 
but of course could not resist the injury thus done to his vital 
organs. The knives were found, after death, distributed in 
various parts of the intestinal canal. I have myself witnessed 
several cases of alarm, from the accidental swallowing of coins 
and other solid bodies. In one instance a boy of eight years 
old, swallowed a pistol flint, remarkably keen and sharp on its 
corners and edges ; yet it passed in two or three days from the 
bowels, without producing the slightest inconvenience. I have 
known but one instance of serious injury from the swallowing 
of bodies of this kind. Two or three years since, a young la- 
dy swallowed a quarter of a dollar ; it appeared to have lodg- 
ed about the commencement of the large intestines, where, af- 
ter a time, it produced great pain and irritation ; after a few 
days the pain would subside, but at an indefinite time return 
like a fit of colic ; producing spasms, fever, and other conse- 
quences of partial inflammation of the intestines. The symp- 
toms are no longer to be traced to a particular point of the in- 
testinal canal, but the disorder continues, and the result is yet 
to be known. 

For these disorders and accidents, we are unable to point 
out any particular remedy. The occasional symptoms which 
may arise, are to be treated according to the circumstances 



worms. 435 

which may be present ; but, in general, it is best to offer no 
remedy, and even the use of a cathartic, would be rather pro- 
ductive of harm than good. 



WORMS. 

Few things are more humiliating, than the contemplation of 
the human body, assailed and destroyed by worms, during the 
life of the individual. The principal varieties of these para- 
sites are found in the intestinal canal ; but there are not want- 
ing instances in which the presence of worms has been dem- 
onstrated, in every organ and tissue of the body. We are as- 
sailed not only by vermin which creep on the surface, and 
disgust our senses, but by worms of a far inferior order, which 
sometimes occupy the cavities, or solid parts of the body, to 
the destruction of health, and even of life. It is our object at 
present, to give some account of these worms, more especially, 
those which are found in the intestinal canal. Of these there 
are five kinds ; two species of tape-worm, one of round worm, 
and two others which have been denominated thread worms. 
Of each of these varieties, we shall take some notice. 

ROUND- WORM LUMBRICUS. 

This worm, although very much resembling the common 
earth-worm, is of a different species, and incapable of living 
when removed from the intestinal canal. It measures from six 
inches to a foot in length, and is male and female, the female 
being much the larger of the two. In color, they are reddish 
brown, with a yellowish tint ; and in their motions, they are 
much more stiff and unwieldy than the common earth-worm. 
Near its tail there is a slit across, forming the anus, in which it 
differs from the earth-worm, whose anus opens at the end. 
The earth-worm is also redder in its color, and has on its un- 
der surface, certain points resembling feet to assist it in craw- 
ling ; which are entirely wanting in the intestinal worm. B\' 
this short description, any one will be enabled to discriminate 
these worms without difficulty. 

The round worm is found, I believe, in all climates, so far 
as the human race extends. They are more frequent, howev- 
er, in some countries than in others ; and are manifestly much 
more common in some districts of the same country, than in 



436 worms. 

others. They are said to attack persons who are in low health, 
whose digestive functions are illy performed, and are a hun- 
dred to one more frequent, so far as I have observed, in the in- 
testines of children, than in those of grown persons. They are 
said to be much more common in low, unhealthy places. Hol- 
land, certain districts in India, and the West Indies, have been 
celebrated for the great number of these parasites, found in 
their inhabitants. lam afraid it would be no more than justice 
to add to this list, the unhealthy districts in the Southern States, 
bordering on the sea coast, and extending over the whole allu- 
vial region, including what has been termed the rotten lime- 
stone country. Nor am I perfectly certain, that the exceed- 
ingly healthful region, that crosses the country above this rot- 
ten lime-stone, is entirely free from this censure ; for intesti- 
nal worms are exceedingly common here. They are often 
found in children who bear marks of the highest health, and I 
think it is not too much to say, that the great majority of those 
raised in this region, between the ages of two and ten years, 
have, at some time, more or less of these parasites in their 
bowels. 

These worms are evidently propagated in the intestines. 
They are found of all sizes, and of great variety as to number, 
sometimes extending to several hundreds. Their growth also 
must be rapid, for I have observed in some instances, after the 
successful administration of remedies for their removal, and 
their discharge in great numbers from the intestines, the same 
remedy may be administered, after a few weeks, with the 
same result. 

From whence, it may be asked, are these disgusting para- 
sites derived ? If they are propagated as the}'- appear to be 
like other animals, how do they find their way into the intes- 
tines of those who were not infested with them ? Observation 
and scrutiny have striven in vain to detect the process by 
which this is accomplished. In times past, when philosophy 
w^as young, when it ran, as it were, in drunken riot, and would, 
not stoop to the laborious investigation of facts ; it was believ- 
ed, that in this, and a thousand other instances which might 
be named, the generation of these low beings was spontane- 
ous ; that it was not the propagation of animals from genera- 
tion to generation ; but that, under certain combinations of 
matter, under circumstances favoring the process, nature, by 
her own and undivided efforts, created these living beings. 
The field for this opinion has been gradually narrowed down. 
The mode in which a great many of these worms are propa- 



worms. 437 

gated, has been discovered and demonstrated ; and the infer- 
ence is forced on us with great strength, that every being, hav- 
ing animation and life, owes its existence to a regular propaga- 
tion, from an original, created by a special Providence. To 
this opinion, 1 confess my self entirely wedded. I have no be- 
lief whatever, in the equivocal generation of any thing which 
has life. I am not insensible to the difficulties which surround 
this question ; or of the weight of authority which might be 
quoted in opposition to my opinion. Those who deny the regu- 
lar generation of these parasites, challenge the production of 
facts to establish their regular propagation. These facts are 
not to be furnished ; but the world is full of analogous cases, 
many of which can be traced through a regular process of gene- 
ration. I have no doubt that the eggs of these worms find their 
way regularly, and without miracle, to the places suited to 
their growth and development. The gad-fly in cattle and 
sheep, and the bots in horses, are easily traced to the eggs by 
which they are propagated. The worm of the intestines never 
becomes a winged insect ; but. like plants, may provide for its 
reproduction by producing myriads of eggs, too small for our 
examination. These eggs may preserve their principle of life 
through every change of circumstances. They may be wafted 
in the air, driven along by the stream, taken in with food or 
drink, or breathed in the atmosphere, and find their way 
through the current of blood to a place suitable to the inscruta- 
ble purposes of nature. This may be difficult to believe ; but 
not near so difficult as the belief in an unproved spontaneous 
vitality. 

I have said that worms are frequently found in the intes- 
tines of children, apparently enjoying the highest health ; I be- 
lieve, however, that they are found in greater numbers in those 
whose health is of a low standard, and especially in the in- 
habitants of low, damp situations. 

The round worm takes up its abode in the small intestines; 
but some times ascends into the stomach, passes up the oesopha- 
gus, to the throat, and even tries to make its escape through 
the nostrils. There is good reason to believe, that they are 
in this way sometimes peculiarly dangerous ; for they have 
been found after death so wedged into the upper orifice of the 
wind-pipe, as to have been a manifest cause of strangulation. 
In other instances, they descend below the small, and into the 
large intestines, where they always seem to be ill at ease, 
striving to make their escape through the anus. 



438 worms. 

symptoms. 

Worms are frequently present in the intestines, without pro- 
ducing any symptom, which may apprise us of their existence. 
It is not uncommon in this country, for careful mothers and 
mistresses, to give to the children of their households, reme- 
dies for worms without regard to the absence of complaint, 
or evidences of high health. In such instances, 1 have, many 
times, witnessed a discharge of many worms from children 
that appeared to be in the enjoyment of the highest health ; yet 
these cases are less common, than the discharge of equal, or 
larger numbers, from those who had previously manifested 
symptoms of their presence. 

The most common symptoms of worms, may be summed up 
in a few words — pains, resembling colic, swelled belly, prick- 
ing at the nose, itching anus, foul breath, and grinding of the 
teeth in sleep, capricious appetite, and great emaciation or 
wasting of the flesh. Graver symptoms are not unfrequently 
attributed to worms — cough, nervous disorders, paralysis, con- 
vulsions, loss of sight, and loss of hearing. These symptoms 
are, as I think, ver} r frequently improperly attributed to worms. 
But the more common symptoms which I have first mentioned, 
are of every day occurrence ; and when they are striking in 
degree, we shall seldom be disappointed in the discharge of 
worms, if the proper remedies are administered. 

It was formerly a common opinion, that these worms were a 
frequent cause of fever ; but this opinion seems to be less ad- 
vocated now. I think that fevers more frequently arise from 
this cause, than is now generally believed. I have often met 
with cases of violent fever, with great pain and tenderness in 
the region of the abdomen, which readily yielded, when the 
discharge of numerous worms was brought on, by the use of 
proper remedies. It is true, a fever of this description will 
commonly yield to the mercurial cathartics, and other remedies 
which we usually administer for worms ; but giving to this fact 
due weight, a patient observation has brought me to conclude 
that the number and mechanical action of these worms of the 
intestines, often produce fever, without any other cause ; in- 
deed it would seem, that it was a rational mode by which na- 
ture would throw off so dangerous an evil. The heat and al- 
tered contents of the bowels in a state of fever, is, I have no 
doubt, fatal to these worms. If a fever of a high grade con- 
tinues for four or five days, in a person who has worms, they 



worms. 439 

are commonly discharged, either entirely dead, or so nearly 
lifeless, as to be scarcely able to move. 

TREATMENT. 

The first object in the treatment, will of course be the dis- 
charge of these parasites from the intestines ; and it is pleasing 
to know that we are furnished with a few remedies having this 
power ; substances poisonous to worms, yet not too poisonous 
to be safely given to patients in whose bowels they are con- 
tained. 

By far the best remedy of this class, is pink root, spigelia 
Marilandica. This may be given in substance, or in infusion. 
A child of six years old may take twenty grains in syrup, even- 
ing and morning, for two days, when it is to be followed by a 
cathartic of castor oil : but the mode in which I most frequent- 
ly administer it, is, to take a quarter of an ounce of the root, 
pour on it half a pint of boiling water, and set it near the fire in 
a covered vessel, for half an hour. Half of this infusion is to 
be given to a child six } T ears old at night, and the remainder 
in the morning. Sometimes it operates as a cathartic of itself; 
but when it fails to do so, after a second portion is taken, a 
dose of castor oil may be administered. These remedies may 
be repeated daily, for one or two days, if it is thought neces- 
sary. This simple treatment is the most successful, which I 
have ever seen adopted for the expulsion of the round-worm. 

But there are Other remedies which are entitled to great, if 
not to equal confidence. The first I shall mention is also a 
plant of common growth in this country, the chenopodium, 
or worm-seed. These seeds have long been used, for the de- 
struction of the round-worm. They are gathered when ripe, 
in September, and given to the extent of a tea spoonful or 
more, mixed in molasses or syrup. This is a convenient, but 
uncertain mode of administering this remedy. If repeated for 
a few days, and followed by some brisk cathartic, if worms 
are. present-, they will be very apt to be brought forth. The 
volatile oil distilled from these seeds, has of late found its way 
into our drug stores ; and forms a more certain means of ad- 
ministering this remedy. From five to ten drops of this oil 
may be given on sugar, or well stirred in syrup. It is pungent, 
and offensive to the taste ; but I have no doubt it is destruc- 
tive to the worm. It may be repeated, from day to day, for 
two or three days ; but in all cases should be followed by a 
cathartic of some kind. 



440 WORMS. 

The pride of India, or common China tree of our streets, af- 
fords also a powerful remedy against worms. I have never 
known it given with much care, to ascertain the quantity ad- 
ministered. The root, fresh from the ground, is taken, and 
the bark pared off with a knife. In this state it is placed in a 
cup ; boiling water is poured over it, and it is placed by the 
fire for half an hour. The root is used in such quantity as to- 
secure a strong infusion ; from half a gill, to a gill of this infu- 
sion, may be given, evening and morning, to be followed with a 
mild cathartic, under the same restrictions observed in the use 
of pink root. It should not be repeated, more than two or 
three clays in succession. 

Now it could hardly be expected, that remedies with pow- 
ers to destroy animals of the low order of intestinal worms, 
could be at all times used without inconvenience. It is rather 
a matter of surprise, that remedies with such powers, could be 
borne at all. With the remedies which I have mentioned, we 
have the greatest reason to be entirely satisfied. I have never 
known serious evil from the prudent use of either of them. 
Pink root, it is well known, produces sometimes a peculiar ac- 
tion on the brain, with some degree of stupor ; which contin- 
ues for many hours. This has occurred under my own hands, 
when I have administered the remedy with all the care of 
which I am capable ; but I never have known it result in death, 
nor have I known the slightest permanent evil result from it 
in any case. I can say quite as much for the worm-seed, when 
administered in substance ; but for the essential oil, especially 
Fahnestock's vermifuge, which from its sensible qualities seems 
to depend for its activity, on this oil, I can not report quite so 
favorably. I have known a violent and dangerous inflamma- 
tion of the bowels brought on by the use of this nostrum. This, 
however, did not prove fatal ; nor do I know that an instance 
can be produced in which a fatal mischief has been done by 
this remedy, in any form. For the pride of India, I cannot 
make quite so favorable a report ; it is frequently administered 
in a random way for the removal of worms, whether present 
or absent ; and it cannot be thought strange that it should 
sometimes be used imprudently. I once knew a servant wo- 
man, by mistaking her directions, to give strong doses of the 
infusion of this root, to several children, twice a day for three 
weeks, without the intervention of any cathartic, or other reme- 
dy which might have mitigated its influence. A low inflam- 
matory, or rather hectic fever followed, of which two of the 
children died, and the rest escaped with some difficulty. Un- 



WORMS. 441 

der such administration of medicine, it cannot fail to do much 
more harm than good. Still I have no hesitation in saying, 
that these three remedies for the round-worm, administered as 
I have advised, are entirely safe. 1 believe them not only 
equal, but far superior, to any other remedy in our possession. 

Since writing the above, I have examined the essays of Doc- 
tor Watson, and Doctors Beall and Stokes, in reference to the 
remedies lor the expulsion of worms. I find that they use 
principally active cathartics for this purpose, especially calo- 
mel and jalap, and other equally drastic purgatives. I have 
no doubt, that these remedies, repeated from day to day, will 
at last expel from the intestinal canal a great proportion of the 
worms it may contain ; but I have not the slightest hesitation 
in prefering the remedies I have above recommended. I ob- 
ject to this repeated use of cathartics, from the great debility it 
causes, and from the irritation or inflammation it would bring- 
on, if too long persisted in. The remedies I have recommend- 
ed, have been called specifics ; and they are well entitled to 
this appellation ; for in their effects on the system, and in their 
sensible qualities we should find it vain to seek for the reasons, 
from which the}^ become poison to worms — they are indeed 
specifics — poison to worms, but not to children. 

I have suggested already the greatest difficulty in the man- 
agement of cases, in which there are worms in the alimentary 
canal ; it is this — they are so speedily reproduced. They may 
be expelled with great certainty ; but how are we to hinder 
their reproduction ? Authors say to us, give tonics, restore 
the tone of the digestive organs of your patient ; and they will 
not reproduce worms. I am far from thinking this as easily 
accomplished as it is advised ; yet I am not prepared to say 
that I have any thing better to offer. When from the treat- 
ment I have advised, worms are expelled from the alimenta- 
ry canal, a course of strengthening or tonic medicines should 
be taken up, and persisted in, for a length of time. This is 
the best that we can do ; and we have the consolation of know- 
ing, that when our patients are from year to year, protected 
from such an enem}^, they are growing older, and less and less 
liable to its attacks ; and that, so far as it regards the round- 
worm in particular ; its presence is not at all to be feared, af- 
ter the age of twelve or fifteen years. Such is my experience 
in the country in which I have lived. 

The favorite tonic of writers is iron, combined with various 
aromatic substances. I adopt with great pleasure the follow- 
ing from Doctor Bell : Take of rhubarb five grains, carbonate 



442 worms. 

of iron ten to thirty grains, ginger five grains, to be made into a 
powder, and given daily in syfup. If the white ginger is used, 
it is of much greater strength, and should be lessened in quan- 
tity. The rhubarb in this prescription, is intended to hinder 
the constipation which frequently attends the use of the prepa- 
rations of iron. Its quantity should be lessened or increased, 
according to its effect on the bowels. 

It would be endless to enumerate the aromatics and bitters 
which have been recommended in these cases. If the vegeta- 
ble tonics are resorted to, gentian is the most powerful. The 
compound tincture of this medicine may be given in doses of 
from twenty to sixty drops, before breakfast, and before din- 
ner. The watery infusions of cherry-tree and dog-wood bark, 
with rue, or other bitter vegetable matters, are proper enough 
in their places. If the patient is much emaciated, and very 
feeble, a moderate use of brandy or wine will be proper. Nor 
should the use of nutritious diet be neglected, for the restora- 
tion of the most vigorous health. An efficient and powerful 
digestion is our greatest reliance against the increase of worms 
in the intestinal canal. 

I have observed, that when persons who have been troubled 
with worms, have acquired a certain age, these parasites make 
their escape from the intestinal canal. I have, in various in- 
stances, been called by children of ten or twelve years of age, 
to witness their expulsion of the round-worm in hardened fae- 
ces, and apparently nearly dead. Such children will not trou- 
ble you again with their complaints of worms. While I am 
writing this, I am informed of a young acquaintance, who, 
within a few days past, became sensible of the presence of a 
worm in his lower intestines. It had been so restless and un- 
comfortable in its place, as to excite a good deal of uneasiness 
in his mind , but it was discharged spontaneously, a day or 
two ago ; and I venture the prediction, that he is to experience 
no farther trouble from the round-worm. 

I have omitted the mention of a class of remedies which 
have been called mechanical ; consisting of crude mercury, 
filings of tin, cowhage, and perhaps some other articles. The 
whole of them are in my opinion, either inconvenient, or ob- 
jectionable. I have never used, and do not recommend them. 

THREAD- WORMS ASC ARIDE S . 

These worms, which are very seldom found in the stomach, 
are from some strange fancy, generally called stomach worms. 
They also most commonly attack children, but with by no 



worms. 443 

means that exclusive pertinacity, which we have seen in the 
round worm. They are not considered dangerous ; but in 
some of their symptoms, they are exceedingly annoying. 

The thread worm, as its name would imply, is very small, 
resembling a white thread, less than an inch in length. They 
are exceedingly active; and, when first voided, throw them- 
selves about with violent contortions. They are said to be 
very perfect in their structure, to be of two sexes, and to propa- 
gate their young in the same manner with more important ani- 
mals. 

There is, so far as I know, but a single symptom, by which 
the presence of this little disturber, is made manifest. This 
symptom is an itching at the anus, not at all times felt with 
equal intenseness, but coming on by spells, with an effect truly 
tormenting. Children are very frequently seen rubbing and 
scratching themselves, to get rid of this annoyance. The part 
of the intestinal canal occupied by these worms, is principally 
the rectum ; and it is here alone, that the symptoms of its 
presence are made manifest. 

The thread worm, although the most insignificant in its size, 
and harmless in its effects, is said to be the most difficult of all 
worms to expel from the body. Purgatives are not considered 
particularly applicable to their removal ; for they are placed at 
the extreme end of the intestinal canal, where they can be af- 
fected by these remedies only at the moment of their exit from 
the body. 

Injections have been thought far preferable in these cases ; 
and the infusions of bitter vegetable productions have been 
thought particularly efficacious. The infusions of quassia, 
camomile, gentian, and other bitters have been recommended ; 
my own preference is in favor of salts and senna. Take half 
a pint of strong senna tea, dissolve in it an ounce of Epsom 
salts, use this as an injection, in such quantity, as the child, 
from its size, may be expected to receive and retain. I have 
seen the thread worm brought away in great numbers by these 
injections. To grown persons 1 have administered purgatives, 
calomel and aloes w r ith very satisfactory results. Aloes and 
senna, in infusion, have been recommended for the same pur- 
pose; but from their offensive taste, I have never advised this 
combination. By a treatment thus simple, I have almost al- 
ways seen the thread worm successfully expelled; and it is 
not from my own experience that I should have classed this 
worm amongst those most difficult to be gotten rid of. 

The pertinacity of this worm in holding on to its position, in 



444 worms. 

spite of all the remedies I have mentioned, has been very much 
complained of by writers. They have advised the use of me- 
chanical means, which I have never found it necessary to re- 
sort to ; but I have no hesitation in recommending those means, 
in cases in which it may be necessary. The torment of these 
worms, when concentrated in great numbers, at their favorite 
resort, the verge of the anus, has led to the use of the finger 
for their dislodgement. A finger dipt in oil, thrust in, turned 
around and withdrawn, is said to have been used to the suc- 
cessful dislodgement of hundreds of them in a moment. A bit 
of candle, or a piece of fat meat thrust in and withdrawn, is 
said to have been equally successful. I have no experience 
with these remedies ; but they are so simple, and at the same 
time, so reasonable, that I have no hesitation in commending 
them to the attention of those who may require their use. 

I must not omit to mention a larger worm, very much re- 
sembling the ascarides I have been describing, being equally 
slender, and of three or four times its length, but which is sel- 
dom seen except in the dissection of dead bodies. Its resi- 
dence is about the centre of the intestinal canal, at the end of 
the small, and the beginning of the large intestines. It is, I 
believe, never found in great numbers; and is not known to 
produce either pain or inconvenience. It is only mentioned 
because the passage from the bowels of a single individual of 
this species, some times give rise to great uneasiness. It is 
sufficient to say, that there is no just foundation for this appre- 
hension, and no remedy required in such cases. 

TAPE-WORM T^NIA. 

This enormous parasite is comparatively rare in this country; 
only two cases of it have come under my immediate notice; 
one in a traveller from the western country, and one in a boy 
a native of this place, Milledgeville Georgia. It is by far the 
largest of the worms found in the intestinal canal. They are 
represented perhaps, with considerable exaggeration, to have 
reached the enormous length of a hundred and fifty feet; they 
are seldom, however, more than twenty feet in length ; and I 
do not give full credit to statements which represent them as 
being much more than thirty feet. Although the largest, they 
are unquestionably the lowest order of worms, having appa- 
rently no voluntary motion, no organs, no division into sexes, 
or any thing but size, to raise them from the very lowest order 
ot^ vitality. 



WORMS. 445 

The name of tape-worm, gives a very good idea of the ap- 
pearance of the animal; its colour is white, and its form is flat 
and extended, very closely resembling a piece of tape. It has, 
however, a manifest head, and near that head a narrowness 
which may be compared to a neck. It is not known, however, 
that it attaches itself by this head, but seems to rest against 
the walls of the intestines, adhering simply by the mucus in 
which it is enveloped ; and sometimes occupying the entire 
length of the intestinal canal. Towards its head it is broader, 
sometimes two thirds of an inch in width ; it is divided into 
joints, and, as it extends towards the tail, becomes narrower, 
terminating as it were in a point. The last joints are some- 
times broken off, and voided from the intestines, resembling 
very much the seeds of cucumbers. 

Of the tape-worm, there are two species, not differing very 
much in their appearance, and having, so far as I know, the 
same habits, and producing the same effects. It is of but lit- 
tle consequence to be able to distinguish one from the other ; 
and there is, so far as I know, no means of doing so, till the 
worm has been discharged from the body. They are found of 
the same species in the intestines of various animals, and es- 
pecially monkeys, dogs, and men. 

The most unequivocal symptom of the presence of tape- 
worm, is the discharge of pieces, ot joints broken off. Wheth- 
er these pieces would, if retained, grow, and serve as a means 
of propagating the animal in numbers, is to me a matter of 
doubt. Nature seldom does things by halves ; and having pro- 
vided the tape- worm with almost an indefinite power of growth, 
so that a single individual may occupy the whole of the room 
which can be afforded it in a single intestinal canal ; it is com- 
monly found alone, and these detachments or portions, if they 
have a vitality susceptible of growth, are still discharged. 
There are, however, some examples of several being found in 
the intestines at the same time. But the symptoms of its pres- 
ences in the bowels, although in the first instance obscure, may, 
after the worm has acquired considerable size, be commonly re- 
cognized. These symptoms are, uneasiness at the pit of the stom- 
ach, which is lessened by the eating of food, irregular appetite, 
sometimes inordinate and craving, and at other times loathing 
of food, itching at the anus, and nose, nausea, pains, as of col- 
ic, grinding of the teeth, and foul, sour breath. They are said 
to occur most frequently in persons who are well fed ; but af- 
ter they have been for sometime in the intestinal canal, a visi- 
ble effect on the countenance is produced. The complexion 



446 worms. 

becomes pallid, the limbs shrunken and emaciated, and the 
belly tumid. These symptoms, it will be observed, are com- 
mon to the round-worm also. An additional symptom which 
is thought to signify the presence of tape-worm, may be men- 
tioned ; the motions of the tape-worm are sometimes obvious 
to the patient, which is seldom the case with the round-worm ; 
although to this also there are exceptions. We are left then to 
the bare suspicion that a tape-worm may be present. When, 
from using without effect the ordinary remedies for the round- 
worm, we are led to suspect the presence of tape-worm, we 
are still without the positive proof that there is a worm of this 
kind present, unless portions of it have been discharged. 

REMEDIES. 

The essential oil, or common spirits of turpentine, has ac- 
quired a reputation for the removal of this worm, which has 
thrown into the shade, the credit due to all others. It is given 
in quantities, which would, from its sensible qualities, appear 
to be enormous. A table spoonful, or even twice this quantity, 
stirred briskly together with an equal quantity of castor oil, 
may be given in the morning, or at any time after many hours' 
fasting. Intoxication and stranguary, the acknowledged con- 
sequences of spirits of turpentine, are said to have occurred 
less frequently under these large, than under smaller doses. 
When they do occur, they are but temporary, and have not 
produced any fatal result in a single recorded case. This 
remedy should be followed with mild cathartics, given from 
six to twelve hours afterwards, such as Seidlitz powder, cal- 
cined magnesia, or rhubarb. These remedies should be re- 
peated, from time to time, so long as the smell of violets is 
manifest in the urine ; for the spirits of turpentine which pro- 
duce this smell should be entirely expelled from the body. 
This remedy apparently so rash, has been proved by sufficient 
trials, to be entirely safe. If the first dose so administered is 
not successful, it may be repeated after a day or two ; but the 
worm, if present, is commonly discharged dead, in a few hours. 
It is but too frequent, however, for a portion of it only to be 
discharged ; leaving the head and some portion of the body 
still alive ; in which case it grows again, and all the troubles 
attending it are renewed. In the only case which I have had 
to deal with throughout its whole course, portions of the worm 
were thus discharged, three or four times in a series of years ; 
but at last the whole worm being discharged, the patient has 



worms. 447 

remained, many years, without any symptom of its presence. 
I will mention one more remedy for tape-worm ; it com- 
mends itself, not only from the reputation it has acquired for 
the discharge of this worm, but from its being a simple vege- 
table substance of safe and very common properties. This 
remedy, is the bark of the root of the common pomegranate. 
Let it be dried and reduced to powder — twenty grains of this 
may be given in any convenient vehicle, hourly, for five or six 
hours, if necessary. But a decoction made from the bark of 
the fresh root rs equally effectual, and has, with many, a de- 
cided preference over the powder. Scrape the fresh bark from 
the root, and boil it in water, so as to make the strongest de- 
coction you can. Of this decoction give two ounces, or a com- 
mon wine glass full ; and repeat it, if necessary, three or four 
times in the course of the day. This also, should it not of it- 
self operate as a cathartic, should be followed by a moderate 
dose of castor oil, or such other mild cathartic, as may be 
thought desirable to give to the bow r els a brisk cathartic move- 
ment. This remedy has been found scarcely less efficient in 
the discharge of tape-worm, than the essential oil of turpen- 
tine. 

GUINEA- WORM DRACUNCULTJS. 

This parasitic worm has its residence in the equatorial, or 
intertropical regions of Asia and Africa. It is often met with 
on the coast of Guinea, and has from thence acquired its com- 
mon name. Its history is but illy understood ; but it is of fre- 
quent occurrence, and is considered infectious, or some way 
transferable from one person to another. It has been so in- 
jurious, in certain instances, where ships had visited the coast 
of these unhealthy countries, that nearly half of the crews of 
armed vessels have been rendered, for the time, unfit for ser- 
vice. 

The Guinea- worm is exceedingly small, slender and long, 
scarcely larger than a thread, and varying from six inches, to 
six feet or more, in length. It seems to enjoy a very low or- 
ganization. Its entrance into the skin is never observed ; but 
the first that is known of it, it is found to have acquired consid- 
erable length, extending along under the skin, or between the 
muscles, through the adipose or fatty membrane, as far as its 
length requires. It is commonly alone, unattended by any 
companion ; but to this there are many exceptions, several be- 
ing found in the same individual at the same time ; and al- 
though the monster has not proved to be of various sexes, its 



448 worms. 

body is often found containing myriads of living young ones. 

For a time, the Guinea-worm seems to produce no inconve- 
nience to those who are attacked by it ; but in its own time, it 
excites an inflammation of the skin very like a common bile, 
causing extensive suppuration, and sometimes hemorrhage from 
the part. The patient is now seriously diseased ; and if, from 
injudicious attempts to extract it, the worm is broken, very se- 
rious mischiefs arise ; suppuration happens in various parts of 
the body, and even life is sometimes endangered. 

There seems to be but one mode of getting rid of this worm. 
When the suppuration has taken place, its head is easily got- 
ten hold of, and by very cautiously extracting it, it may be en- 
tirely removed, and the place it had occupied will readily heal 
leaving very little injury. But it is exceedingly dangerous to 
attempt the entire extraction at one time ; a few inches may at 
first be extracted, and should be rolled on a small stick, or 
something of the kind, and secured in its place. Sometimes 
the extraction cannot be effected for many days, or even weeks; 
and great care is to be taken that the body of the worm is not 
broken in the process. In some instances, the course of the 
worm may be felt under the skin for a great distance ; in which 
case it is advisable to cut down to it, at this point ; and hav- 
ing passed something under it, both ends may be thus extract- 
ed at once. 

WORMS NOT FOUND IN THE INTESTINAL CANAL. 

Besides the worms usually found in the intestinal canal, 
there are met with, in other parts of the body, several varieties 
of organized, animated beings of this description. They de- 
scend to the very lowest order of creation; and some that have 
been denominated worms, seem to be scarcely entitled even to 
a name so low. 

It is very rare to meet with worms in any other part of the 
body, except the intestinal tube. In certain cavities, however, 
worms are occasionally met with. I have, in two instances, 
seen them discharged with the urine ; whether originating in 
the kidneys or bladder I had no means of ascertaining. These 
worms were, in one of these cases, very numerous ; about an 
inch in length, apparently well formed, having red heads ; they 
were discharged dead, so that their motions were not observ- 
ed. Considerable irritation of the kidneys and bladder attend- 
ed this case ; but there was nothing peculiar in the symptoms 
which might have indicated the presence of these worms. The 



worms. 449 

gall-bladder, which has a duct through which its contents are 
discharged, and has thus far some resemblance to the urinary 
bladder, is sometimes found to contain worms. There are no 
symptoms, so far as I know, by which their presence may be 
suspected before death. In various other situations, worms ap- 
parently fully organized, have been met with, even in the solid 
parts of the body. Other animals besides men, are apparent- 
ly more subject to the attacks of these parasites. I have seen 
in the eye of a horse, a white worm which played about in the 
humours of the eye, with great activity. The vision of the 
eye was destroyed, and the horse appeared to be in great pain; 
but there was neither swelling nor any other alteration of the 
eye, by which its presence could have been disclosed. It was 
in the chamber of the eye, behind the iris, and was apparently 
two inches or more in length; but was only seen when from its 
movements it passed before the pupil of the eye. I had no op- 
portunity of seeing it after it was extracted. All these cases 
are so rare, that it is only necessary to mention them in this 
place. They are, in most instances, beyond the reach of our 
investigations or remedies. 

There is yet a lower order of worms, which are sometimes 
found in the human body; they are most frequently met with in 
the liver; but they are sometimes found in the adipose sub- 
stance, in other parts of the body, forming for themselves sacks, 
in which they enjoy their very low order of existence. There 
is hardly a single part of the body in which animals, if indeed 
they be animals, of this kind have not been met with. The 
form of these creatures is that of a bladder, or little sack; they 
are denominated headless ; and they form one within another 
like boxes, containing several, one within another. They are 
filled with a watery fluid ; and the whole, for the most part, 
perfectly transparent. Low as these creatures are, they are 
sometimes formidable, even fatal. In the liver, they grow to 
a great size, producing inflammation and suppuration. Ab- 
scesses from this cause have frequently been opened, and many 
of these sacks discharged. Now this whole tribe admit of no 
medical treatment. If they form abscesses which can be open- 
ed, and their contents discharged, there is a hope of the final 
recovery of the patient ; but the disorder is generally fatal, 
and we are left with the single consolation, that it is rare. 



29 



450 DISEASES OF THE LIVER. 



DISEASES OF THE LIVER. 

From the great size, important functions, and central posi- 
tion of the liver, its diseases are matters of the deepest inter- 
est. In this climate it is by no means rare to find this organ, 
in a state of disease totally destructive of health, and danger- 
ous to life. It cannot be said, however, that these diseases are 
very various in their character. Those met with most fre- 
quently, arise from disorders of the digestive functions; but the 
autumnal fevers of this climate are productive of great disor- 
der in this organ. Inflammation, either acute or chronic, 
forms the principal derangements which are met with in the 
liver. Other diseases, it is true, are of frequent occurence in 
it : but even these are all productive of more or less inflamma- 
tion, and it is commonly left to post mortem examinations to 
point out their particular character. 

INFLAMMATION OF THE LIVER. 

This disease is divided into the chronic and acute forms. 
These forms are less distinct in this, than in other organs of the 
body, in consequence of the low degree of sensibility in the 
liver, which lessens the intensity of pain, even when its in- 
flammation is most acute. Nor is it easy to decide, to which 
class, the accute or chronic, a particular inflammation of the 
liver belongs. It may be best, however, to treat of this dis- 
ease under the divisions which have been found so useful in 
other cases. We shall, therefore, first take into consideration 
the disease in its acute form. 

ACUTE INFLAMMATION OF THE LIVER. 

This form of inflammation of the liver is known by the sud- 
denness of its onset, on persons who had previously enjoyed 
good health. It comes on with sharp, severe pain in the right 
side, extending from the region of the liver to the shoulder ; 
and, in some cases, extending even to the left shoulder, and at- 
tended with fever, sometimes, very high. The patient is una- 
ble to lie on his right side, breathes with some difficulty, is fre- 
quently affected with hickup and vomiting, sometimes throw- 
ing up large quantities of dark bile. Cough also is present in 
this disease ; and in this we find the greatest source of obscu- 



DISEASES OF THE LIVER. 451 

rity in understanding it. For the cough is naturally referred 
to diseases of the lungs; but in this disease, the cough is dry 
and short, and is frequently absent, except when brought on 
by some movement of the patient. Great variety is found in 
the symptoms of different cases of this disease. The pain is 
sometimes sharp, at others dull, sometimes most acute at the 
top of the shoulder, at others extending along the collar bone 
towards the neck. Jaundice is sometimes, but not always 
present. The main reliance in forming a judgement of the 
remedies which should be used, is to be formed from the vio- 
lence of the fever, and the rapidity manifest in the course of 
the disease. Acute inflammation of the liver, is of itself a 
violent and formidable disease ; and the patient sinks under it 
in a manner very distinct from the slow and imperceptible 
movements of the chronic inflammation of this organ. Reme- 
dies, therefore, are to be used in proportion to the violence and 
intenseness of present symptoms. 

Acute inflammation of the liver, like other diseases of like 
kind, tends to a speedy dissolution or destruction of the organ. 
Suppuration is, I will not say in this climate, a frequent occur- 
rence ; but from the accounts we have of its ravages in the 
Eastern Hemisphere, it is there very common. In this cli- 
mate, however, a lower degree of disorganization and injury is 
apt to occur. The liver adheres by its external surface to the 
outer wall of the abdomen, a chronic inflammation ensues, 
sometimes the function of the liver becomes deranged, pro- 
ducing diarrhoea or jaundice ; but it will rarely, under proper 
treatment, terminate in death. The disease in this climate is 
not of common occurrence. It seldom arises in bilious fever ; 
and, in this respect, as before suggested, it differs widely in its 
history here, from that which is written of it in the East. 

When suppuration in the substance of the liver occurs from 
acute inflammation, it is apt to produce an abscess of enor- 
mous size. It is easily felt through the walls of the abdomen ; 
and, being closely pressed by surrounding organs, by a benefi- 
cent law of nature, adhesion takes place ; and the matter with- 
out escaping into the peritonaeum, finds its way towards the 
surface. The parts covering it become at last so thin, that the 
fluctuation of the matter becomes very obvious, and the ab- 
scess may be opened with ease and safety. Sometimes this 
adhesion takes place between some portion of the intestines 
and the liver; the parts give way before the pressure of the 
matter, and an opening into the intestines is made for its es- 
cape. In other instances, it penetrates in like manner into the 



452 DISEASE'S OF THE LIVER. 

lungs, from whence it is coughed up, relief obtained and life 
preserved, even under circumstances so perilous. But patients 
are not always so fortunate in this disease. The pus sometimes 
bursts forth into the cavity of the abdomen, before sufficient 
adhesion had taken place, and death speedily follows. The 
operation of puncturing being sometimes prematurely perform- 
ed, leads also to the same result. And there are not wanting 
cases in which the matter has opened a way for itself into 
some of the larger blood vessels, throwing at once an enormous 
quantity of pus into the blood, which produces a speedy disso- 
lution. 

TREATMENT. 

This, like other acute inflammations, is to be treated with 
remedies corresponding with its violence. Bloodletting should 
be resorted to without delay, and repeated within a reasonable 
time, if the disorder does not give way. Leeches over the re- 
gion of the liver, are strongly recommended ; but in this, as in 
other inflammations of deep seated organs, I think they are to 
be placed among the second rate remedies. Blistering exten- 
sively, after copious bleeding, is, I have no doubt, a most valu- 
able prescription. Cathartic remedies have been offered with 
more hesitation ; and calomel, especially, has been thought not 
very desirable in the onset of the disease. It is true, cathartics 
give motion- to the intestinal canal, promote an active secretioo 
of bile, and thus specially stimulate the liver. These, it is 
true, are objections to cathartics ; but they are, in my opinion, 
far outweighed by the valuable effects of these remedies, in re- 
ducing inflammation, and discharging the detained contents of 
the liver and intestines. Even in the East, we have high au- 
thority for the use of calomel in large doses ; and its ordinary 
effect, a salivation, has by some been looked for with the great- 
est anxiety. For my own part, I have no hesitation in recom- 
mending for this inflammation, the same remedies which have 
been found proper in inflammation of other organs. I should 
give calomel in doses, of five grains, repeated three or four 
times in twenty-four hours, with such use of the antimonial 
mixture, as the stomach might bear, without producing too 
much vomiting. I should begin with a table spoonful every 
two hours, and increase or lessen the quantity, according to the 
effect produced by it. In this decided way, I should treat 
acute inflammation of the liver ; persisting in my remedies as 
long as the strength of my patient, and the violence of the fe- 
ver seemed to require and justify their use. 



DISEASES OF THE LIVER. 453 

I have not mentioned opium as a remedy for this disease. 
It is only necessary where, from the intenseness of the pain, or 
the prostration attending the severe operation of medicines, it 
may seem to be particularly demanded. It should be given in 
full doses and at long intervals ; and unless the symptoms were 
rather extreme, I should avoid its use altogether, till suppura- 
tion has taken place and the matter of the abscess is dis- 
charged. 

When this disease is of a high grade, and gives way suddenly, 
the patient will require such support from strengthening reme- 
dies, as we are. in the habits of using, under like circumstances. 
Quinine, in doses of two grains, repeated six or eight times in 
the twenty-four hours, may he administered lor a few days* 
Brandy, in such light portions as may seem admissible, will 
also be proper. But should the disorder seem to terminate im- 
perfectly, it becomes chronic ; and we shall consider more ful- 
ly its mode of treatment hereafter. 

CHRONIC INFLAMMATION OF THE LIVER. 

The symptoms of chronic inflammation of the liver, differ 
mostly in degree, from those which have been described in the 
acute. The degree of fever which attends it is much lower, 
sometimes not noticed at all. The patient, in many instances, 
continues in the ordinary pursuits of life, sensible that he is 
very unwell, and having commonly considerable accession of 
fever at night. The liver, in these cases, is often so much 
swollen, that it may be felt passing out from under the ribs of 
the right side. It is seldom very tender ; a considerable pres- 
sure may be made on it, without inflicting much pain. In oth- 
er instances, however, the liver is not enlarged, and cannot be 
felt in this way. More or less pain, however, will be felt in it, 
and the shoulder on the right side, will probably experience 
fully as much pain as the liver itself. I have known the pain 
to extend to both shoulders, producing great inconvenience to 
the patient while he remained in bed, and a stiffness of the 
arms in the shoulder joints, which render motion extremely dif- 
ficult. At the same time, the liver, although swollen and easy 
to be felt, seemed to experience but little soreness, and scarce- 
ly any pain. 

CAUSES. 

The symptoms of chronic inflammation of the liver are so 
obscure, that a reliable judgement can hardly be formed of it, 



454 DISEASES OF THE LIVER. 

without the study of its remote causes. When the case is a 
termination or extension of the acute disease, its nature will be 
more readilv ascertained. In addition to acute inflammation, 
the chronic form of this disease frequently arises from chill 
and fever, or the autumnal fever common in this climate. The 
abuse of distilled or fermented liquors, is no uncommon cause 
of it. And when the habits of the individual complaining of 
the symptoms we have mentioned, are those of excess, the pre- 
sumption is very strong in favor of the liver being diseased. 
In addition to these, the liver seems to have causes peculiar to 
itself — the formation of hydatids frequently takes place in this 
organ, producing an inflammation, as slow as it is unmanage- 
able. 

Great emaciation, or wasting of the flesh, is the common 
consequence of chronic disease of the liver ; the complexion 
becomes sallow, and a low dry cough is observed ; great des- 
pondency of the mind, swelling of the feet, and finally a drop- 
sy of the abdomen, too frequently brings this disorder to a close. 
Jaundice is the very common attendant of this disease ; but it 
is by no means essential lo it, for I have seen in some, a bright- 
ness of the eyes, and a waxy paleness of the face, and espe- 
cially of the ringers, which I have met with in equal degree in 
no other complaint. 

TREATMENT. 

The treatment of chronic inflammation of the liver, does not 
differ widely from that of other disease, of low inflammatory 
action. A great degree of prostration usually attends the dis- 
ease, and bloodletting, so necessary to combat the inflamma- 
tion, is advised to be done by means of leeches. Mercury in the 
form of calomel, four or five grains at a dose, repeated daily, is 
also advised; but purgatives of salts, or salts and senna, are ad- 
vised, to be used from time to time, to prevent a salivation 
from taking place. If the patient is not too much reduced, 
moderate exercise is advised, and the use of food that is not 
too poor or innutricious. Iodine, given in moderate doses, say 
ten drops of the tincture twice a day, may be continued for a 
week or two at a time ; and, in the event that the case proves 
obstinate, great stress is laid upon the advantage of sending 
such patients to such mineral waters, as have a cathartic ac- 
tion ; such, for instance, as the waters of Saratoga. 

This treatment may answer for cases attended with great 
degree of prostration, and where the powers of the patient are 
already nearly exhausted, My own opinion is, that it is suited 



DISEASES OF THE LIVER. 455 

only to cases that are already almost hopeless. Where the pa- 
tient has any constitutional power left, which may be relied en 
to sustain him under treatment at all active, I advise a much 
more vigorous course. 

Bloodletting is, in my opinion, by far the most important 
remedy in the treatment of chronic inflammation of the liver. 
It is a prevailing notion, that this is the most exhausting of all 
remedies, and therefore unsuited to the treatment of diseases in 
which there is a great degree of debility. It is true, that blood- 
letting may be so used as to be the most exhausting of reme- 
dies ; but, over other exhausting remedies, it has the advan- 
tage of being used just to the degree we desire, and no farther. 
It may be taken by weight and measure ; and in no disease is 
it more proper to regard the exact quantity of blood drawn, 
than in that which we have now under consideration. I know 
no disease in which I have used moderate and frequent bleed- 
ing with more advantage than in this. I have bled patients, 
from whom I thought it unsafe to take more than six ounces of 
blood at a time, and yet have found them to improve under its 
effects, while it was repeated, once or twice a week, for months 
together. If I were to select a disease, which having to all ap- 
pearance the most fatal tendency, and would yet give way to 
perseverance in the use of this remedy, I should instance chronic 
inflammation of the liver. I shall not forget an instance in 
which, from the extreme sensibility of my patient, his skin 
could not endure the application even of mercurial ointment 
without being covered with blisters ; and whose intestinal ca- 
nal had become so excitable, that even a grain of calomel could, 
not be tolerated, but acted as a violent cathartic ; and yet this 
case yielded to the lancet, and a perfect cure was effected by 
drawing eight ounces of blood at a time, about twice a week, 
for three months. I have had many similar examples of the 
good effect of bloodletting, when used in this way ; and I 
scarcely know- to what degree of prostration the patient is to 
be subdued, before he can be pronounced too low to admit of 
bloodletting:. 

o 

Where there is much fever, with corded pulse and consid- 
erable restlessness at night, the antimonial mixture is a power- 
ful and necessary remedy. It should be given in broken doses, 
say a table spoonful once in two hours, during that portion of 
the day in which the fever is highest ; but it is not to be per- 
sisted in, after it operates on the bowels as a cathartic ; and 
probably it will seldom be necessary to give more than three or 
four closes of this medicine, in the twenty-four hours. 



456 JAUNDICE. 

Calomel is another remedy of no secondary value in this 
disease. I have great faith in giving three or four grains a 
day, till a slight salivation is brought on ; but I have frequently 
met with cases in which of all remedies this appeared to be 
tolerated the least by the bowels of the patient ; even a grain 
or two producing a great many operations as a cathartic. I 
have, in such cases, made application of mercurial ointment to 
the skin; and where I have found it disposed to inflame the 
surface and produce blistering, I have still repeated it from day 
to day, by making an application first on one part, and then on 
another of the body ; and it is after a persevering use of mer- 
cury in cases like this, that I have seen the greatest benefit 
from it, when a slight salivation was brought on by it. 

In the treatment of this disease, its chronic character should 
never be lost sight of. It should all the time l^e recollected that 
the reduction of the circulation to a given point, would not ef- 
fect the removal of the low inflammation and disordered struc- 
ture of such an organ as the liver. Time is required for this 
process ; and he who, by violent measures, pushes to the ex- 
termination of the disease, should be well on his guard, for the 
efforts he makes may thrust his patient over a precipice from 
which he cannot recover him. 



JAUNDICE— ICTERUS. 

This disease is universally known by the yellow color it gives 
to the skin. In the negro, this yellowness is seen only in the 
whites of the eyes ; but here it is truly conspicuous. The yel- 
lowness extends to every part of the system, far beyond the 
circulation of red blood ; it is not only seen in the whites of 
the eyes, and in the urine and perspiration, but extends, in 
some cases, even to the humors within the eye, giving to every 
object the same yellow tinge in its appearance. While this is 
the case throughout the body, and in all the fluids which pass 
from it, the contents of the intestinal canal lose their accus- 
tomed hue, and become pale, ash colored, or white. While 
this continues, the yellowness of the skin is on the increase ; 
the patient acquires a greenish hue, sometimes so dark as to 
have acquired the name for it, of black jaundice. 

In addition to the yellow color of the skin and secretions, 
jaundice is usually attended with symptoms sufficiently dis- 
tressing — vomiting, hickup, and sour eructations, flatulency, 



JAUNDICE. 



457 



languor, despondency, and more or less pain about the pit of 
the stomach. This pain is rather mitigated by pressure ; and 
patients are seen leaning on the edge of a table, or in other 
similar situations, for relief. The skin is usually cold, with oc- 
casional chilliness; but sometimes fever is brought on, and con- 
tinues throughout its whole course. 

Jaundice arises from many causes. It consists, no doubt, in 
the presence of an enormous quantity of bile in the blood ; but 
this bile is thrown into the blood in various ways ; those which 
investigation has rendered obvious, are purely mechanical. 
In its passage to the intestines through the gall-duct, the bile is 
sometimes arrested by gall-stones, or bile wmich has, from some 
cause, become too tenacious or thick to flow through so narrow 
a passage. Pressure on these ducts from any external cause, 
a tumor in the liver, or any adjoining organ, may produce the 
same effect. But the disease frequently arises, without any 
cause of this hind, or any other that we can pretend to assign. 
It is sometimes an epidemic, affecting a great many individu- 
als about the same time, and has been known to arise from va- 
rious occasional causes. It is met with most frequently in old 
persons ; but is occasionally seen even in an infant of a few 
days old. 

TREATMENT. 

When jaundice arises from internal and incurable organic 
diseases, it is manifestly very little under our control : but it is a 
very frequent disease, independent of such causes ; and al- 
though exceedingly disagreeable, cannot be regarded as very 
dangerous. The great object in the treatment, is to produce a 
flow of the bile into the intestinal canal. This is effected by 
^emetics or cathartics, mercurial cathartics especially. I am in 
the habit of using the most active cathartic medicines : take of 
gamboge eight grains, calomel twenty grains, make it into six 
pills, give two of these pills every four hours, till free evacu- 
ations of the bowels are brought on. If these evacuations are 
found to be of a dark color, the cure will probably follow with 
but little delay ; if they retain their whiteness, the patient will 
probably experience no relief, and the dose should, after a day 
or two, be repeated. In many instances, the disease will fail 
to give way to these remedies. It will take its own slow time ; 
but when this is allowed, the bile will seem to be re-establish- 
ed in its course, without any reference to the remedies used ; 
and the patient will speedily recover. Whatever nostrum may 
have happened to be used at this time, usuallv obtains the cred- 



458 DISEASES OF THE SPLEEN. 

it of the cure ; and hence it is that no disease whatever has 
been thought to be cured by so many remedies, while in truth 
it is under the influence of so few. 

Jaundice, when it occurs without any mechanical obstruc- 
tion, as a common epidemic disorder, will commonly yield in 
a few days to the remedies I have mentioned ; but it frequently 
lingers in our hands ; our patients become feverish, and the 
disease seems to be dangerous. Bloodletting is sometimes 
beneficially used here ; if the pain about the pit of the stomach 
is troublesome, laudanum may be given, forty drops once or 
twice in twenty-four hours. Warm bathing is thought to be 
beneficial ; and the crude and acid contents of the stomach are 
beneficially removed by the use of carbonate of soda, or pre- 
pared chalk. 

During the whole course of the treatment, the state of the 
bowels is still to be regarded ; and, an occasional use of cathar- 
tics should not be dispensed with, so long as the discharges re- 
tain their pale, ashy color. 

The state of the stomach, the absence of fever, and the de- 
cline of strength, in these cases, have caused us to look for 
much benefit from tonic medicines. Every physician who has 
tried them, will acknowledge that they are but too apt to dis- 
appoint us. If tonics are given, the watery infusion of bitter 
vegitable substances is to be preferred. Camomile tea has 
been much used in these cases ; but I prefer to take half an 
ounce of gentian, cut into small pieces, unite with it, a drachm 
of ginger or cloves, pour on a quart of boiling water, and give 
a wine glassful of this infusion four or five times a day. An in- 
fusion of the bark of the wild cherry tree made in the same way, 
has been much used in this country, and I believe is entitled to 
as much confidence as any remedy of the kind. 



DISEASES OF THE SPLEEN. 

This organ is very subject to be thrown into a state of chron- 
ic inflammation from the influence of malaria, or the diseases 
which arise from that cause. With this exception, the spleen 
is probably the least subject to disease of all the organs in the 
body. I think, I can safely say, that I have never found any 
serious disorder in this organ, but what has been fairly attribu- 
table to this cause. But a perfect immunity from other disea- 
ses cannot be asserted to exist in this organ. We accordingly 



DISEASES OF THE SPLEEN. 459 

find that in a few rare cases, it has been found, on post mortem 
examinations, in a state of disease. It has been remarked, 
that these disorders have been but little studied ; and, so far 
as its diseases are concerned, my remarks will be very much 
restricted to those which have been brought on by the autum- 
nal diseases of this climate. 

Although the diseases of the spleen are, as I have stated, al- 
most exclusively attributable to the same cause, they are nev- 
ertheless exceedingly common in the unhealthy districts of low 
latitudes. Certain districts of India, Italy, Holland, and South 
America, have been thought to furnish the greatest number of 
these cases. The Southern Atlantic coast of the United States, 
and the Gulf of Mexico, with a large district of interior country 
in which intermittent and bilious fevers prevail, will, I appre- 
hend, present its full proportion of cases of the disorders of this 
organ. It may be proper to state that persons of color are 
much less subject to chronic diseases of the spleen than white 
persons. 

Great uncertainty still hangs over the question, what are the 
uses of the spleen ? It appears manifest that its functions have 
no resemblance to those of the liver and kidneys. The opin- 
ion which seems to have the most advocates, is, that from its 
capacity of great distension, it serves the purpose, when the 
blood is thrown into violent circulation, of protecting other or- 
gans from injury, by receiving into its substance, in a tempo- 
rary way, a great amount of blood which would endanger 
those organs. But this distension of the spleen seems to pro- 
duce no ill effect, except when caused by the paroxysms of in- 
termittent, and other malarious fevers. 

INFLAMMATION OF THE SPLEEN. 

The acute inflammation of this organ is by no means a com- 
mon disease. I have met with it, however, in persons who had 
been laboring under the chronic inflammation or distension of 
the spleen, and were, in that condition, exposed to some addi- 
tional cause of inflammation. I have, in these cases, found the 
disease very acute in its symptoms ; the fever very high, and 
the pain and swelling of the spleen extreme. The rapidity of 
its enlargement, is truly astonishing. I have seen it in a few 
hours, seem to be so enlarged as to fill almost the whole cavity 
of the abdomen. I do not know that I have ever witnessed a 
rupture, or hemorrhage from this organ ; all the patients I have 
treated in this painful disorder have recovered, and having re- 



460 DISEASES OF THE SPLEEN. 

covered, I infer that no rupture of its investing membrane took 
place. It is hardly necessary to say more, as to the symptoms 
of acute inflammation of the spleen. Its situation in the body, 
should be known to every one ; its violent and sudden enlarge- 
ment will be obvious, and the pain will be very much confined 
to the organ itself. These symptoms, with the fever which at- 
tends them, will hardly be mistaken for any other disease. 

In its treatment, the acute inflammation of the spleen is ex- 
ceedingly simple ; bloodletting, promptly resorted to, and pret- 
ty copiously done, is our main reliance. Cold applications over 
the region of the abdomen, should be added ; and a moderate 
pressure by a suitable bandage, will limit the distension in a 
considerable degree. By this treatment, comparative ease will 
commonly be obtained in a short time ; but cathartic medicines 
should be administered without unnecessary delay. If the dis- 
ease continues, it will put on the symptoms of chronic inflam- 
mation, of which we are next to treat. 

CHRONIC INFLAMMATION OF THE SPLEEN. 

I believe the spleen is always enlarged when inflamed. If 
there are exceptions to it, it has not occurred to me to witness 
them. When the inflammation is of a kind termed chronic, the 
organ has no great degree of sensibility. It may be felt with 
the hand passing out from under the ribs on the left side, ad- 
mitting of considerable pressure without producing a great deal 
of pain. There, however, some^pain and weight are felt by the 
patient in the spleen, and some degree of fever attends the en- 
largement. In such cases, the complexion is sallow, with 
great debility and emaciation, or wasting of the flesh ; a short 
dry cough, and sometimes vomiting, and occasional diarrhoea, 
are present. These symptoms continue for an indefinite time, 
and although, in many cases, exceedingly mild, are not to be 
disregarded ; for the disease, although slow in its progress, is 
not void of danger. Left to pursue its own slow course with- 
out interruption, it is hard to anticipate the various disorganiza- 
tions and injuries, to which it may give rise. Its favorable ter- 
mination is by resolution, in which case the disease gradually 
subsides, and is well. In some cases hypertrophy, or enlarge- 
ment of the organ, happens, and scarcely admits of its again 
returning to its original size. The suppuration and gangreen 
described by authors, I have not witnessed. 

TREATMENT. 

In chronic inflammation of the spleen, it is to be borne in 



DISEASES OF THE SPLEEN. 



461 



mind, that the part affected has but little sensibility, and great 
powers of endurance. It is so prone to continue for a great 
length of time, and so little capable of being relieved by a sud- 
den impression made on the circulation by remedies, that it is 
to be treated with those which are entirely mild, although it is 
necessary to continue them, for a length of time. Bloodletting 
by leeches, is highly spoken of, although I do not prefer it to 
small quantities of blood drawn from the arm, at different 
times. Blistering is a remedy of great value in these cases ; 
it should be repeated from time to time, according to the symp- 
toms. Mercury, used to bring on a salivation, is spoken of 
with a great deal of doubt. My own opinion is decidedly in its 
favor. Calomel may be given in doses of five grains every 
night, till its effect becomes obvious in the mouth. But this 
remedy admits of only occasional use ; it cannot be repeated 
so often as the tedious character of this disease might seem to 
require. As soon as a salivation appears, let the remedy be 
dispensed with, for a month at least. Iodine, given internally, 
twenty drops of tincture twice a day, for a week or ten days at 
a time, will always be found a valuable remedy. 

When the inflammation continues with some pain, tender- 
ness, and fever, the antimonial mixture is not to be forgotten. 
A table spoonful of this mixture, three or four times a day, will 
be found of much service. If it is found to produce vomiting, 
the dose may be lessened ; but the remedy should not, on that 
account, be abandoned. 

The great debility and pallid hue of patients with this dis- 
ease, prompt us to seek for restoratives and tonic remedies, 
at the earliest possible time. I think they are commonly re- 
sorted to, too early ; and I give it as my opinion, that they should 
not be given during the presence of fever ; but when from the 
absence of fever we feel authorised to administer tonics, the 
preparations of iron are unquestionably the best. The carbo- 
nate, or the precipitated carbonate of iron, may be made into 
pills of four grains each, and three a day given to the patient. 
If costiveness proves an inconvenience, about two grains of 
aloes may be added to each pill. The sulphate of iron, or 
common copperas, has been much, and beneficially used in this 
country. The dose is about three grains, to be given three or 
four times a day; it may be conveniently made into pills by 
placing it near the fire, in an iron vessel, till it falls down into 
a white powder, and then making it into pills with turpentine. 
The acetate of iron, made in a rude way, by pouring vinegar 
on the carbonate of iron, or on nails or iron filings, is objec- 



462 DISEASES OF THE SPLEEN. 

tionable only because of the ofFensiveness of its taste. Half a 
table spoonful, or a table spoonful, if the stomach will bear it 
without vomiting, may be taken before breakfast, and before 
dinner. I have seen this preparation of iron used, with as 
much benefit as any other. 

I have advised the internal use of iodine ; and I have seen 
the best effects from the application of this remed}- externally ; 
let forty grains of iodine be dissolved in an ounce of alcohol, 
and apply this over the region of the spleen by means of a 
feather ; the application should not be continued over one or 
two minutes at a time, for if it is, it will produce blistering, 
with considerable unnecessary pain. It should be used just to 
the extent that it can be, to avoid blistering ; and may be re- 
peated twice or three times a week. 

I have stated that this disorder commonly arises from fevers 
of the intermittent kind ; in some cases the patient will have 
an occasional sharp paroxysm of chill and fever, and, in other 
instances, a very low and scarcely visible disorder of the same 
kind. Every attack of this kind tends to aggravate and pro- 
tract the disorder, and the greatest care should be taken, to 
remove the intermittent fever, however obscure or low its 
symptoms. It is pleasing to know that we have a remedy, as 
peculiarly adapted to the removal of these low fevers, as the 
lever itself is to the production of inflammation of the spleen. 
This remedy is sulphate of quinine. If the paroxysms of the 
fever are manifest, the time at which they are expected should 
be anticipated by the use of this remedy. Divide fifteen grains 
of quinine into eight doses, begin six hours before the expected 
chill, and give one dose hourly, till the whole are taken. This 
course is to be repeated, from time to time, as the occasion for 
it may occur ; and it is to be remembered, that no active, de- 
pleting remedies should be used, within a week after the qui- 
nine has been used, as here directed. For, I can hardly be 
mistaken in the fact, that any remedy used to produce a sud- 
den reduction of strength at such a period, will endanger the 
re-appearance of the chill. 

I have noticed in a late publication, the recommendation of 
quinine, as the sole and exclusive remedy for chronic inflam- 
mation of the spleen. I have no doubt, that in cases connect- 
ed with an obscure and half cured intermittent, the success of 
this treatment will be marked and satisfactory. But I am not 
prepared to believe, that after the disease becomes chronic, 
and the intermittent fever entirely gone, it will be safe to rely 
entirely on quinine. The course I have recommended, I have 



DISEASES OF THE KIDNEYS. 463 

adopted and pursued successfully, in a great many instances. 
It will almost always succeed, where the patient is removed 
from those causes which produce intermittent fever ; but to 
those who are from circumstances unable to choose a residence 
for themselves, and are thus compelled to remain where they 
experience an attack of intermittent fever every year, it is ob- 
vious, we dare not promise so favorable a result. 



DISEASES OF THE KIDNEYS. 

Every one should know, that from the kidneys flows the 
urine ; and, that this urine, although so much in its common 
appearance resembling water, is excrementitious matter, fully 
as offensive as any which is discharged from the body. It is 
the office of the kidneys to separate this matter from the blood, 
and the arrangements of nature to accomplish this object are 
very ample. The arteries which carry blood to the kidneys 
are so large, that it is obvious the whole of the circulating blood 
passes through them, many times every day. And the quanti- 
ty of excrementitious matter which is thrown off from these 
organs, in some states of disease, is truly astonishing. 

Few subjects have been more investigated than diseases of 
the kidneys, or diseases which change the character, appear- 
ance, and properties of the urine. There is still, however, a 
great degree of obscurity hanging over this subject. Changes 
in the state of the urine do not always signify a disease in the 
kidney ; on the contrary, the kidney often performs but a 
healthful office, in separating from the blood the matter of red 
gravel, or even the more dangerous kinds of calculi, which so 
often give rise to the most painful and dangerous disorders. 
Of late, chemistry has made great advances in the investiga- 
tion of this subject ; a few decided improvements have thus 
been made in the treatment of reinal diseases ; and with the 
lights which have thus been afforded us, we shall be bet- 
ter able to point out the proper method of treatment, in diseases 
of the kidneys. 

INFLAMMATION OF THE KIDNEYS NEPHRITIS. 

The kidney, like the other organs of the body, is subject to 
inflammation, which may arise from injuries to the part, or 
from cold, or other remote causes of inflammation ; but by far 



464 DISEASES OF THE KIDNEYS. 

the greatest number of cases of this disease, arise from gravel, 
which is deposited from the urine in a small irregular cavity at 
the side of the kidney, which has been termed its pelvis. In- 
to this cavity, the urine is first discharged , and from thence it 
descends by a small tube, the ureter, several inches in length, 
to the bladder. Gravel is deposited from the urine in the pel- 
vis of the kidney, where it sometimes acquires considerable 
size, producing irritation, and the inflammation which we are 
now considering. 

The situation of the kidneys is towards the back, immediate- 
ly opposite the loins. Inflammation in these organs, produces 
pain which is felt in this region. Sometimes the pain is on one 
side only ; for one kidney is many times affected, while the 
other is not. The pain is sometimes very acute, but in others 
dull and low ; it is increased on moving, and the testicle on the 
same side is frequently drawn up, while a benumbing pain ex- 
tends down the thigh. When the attack is sudden and violent, 
the urine is discharged frequently in small quantity; and great 
nausea, and violent vomiting take place. Fever of the inflam- 
matory kind, sometimes, with frequent chilliness, occurs in the 
midst of the disease. 

The discrimination of this disease from lumbago, or inflam- 
mation of the muscles of the back and loins, is not always per- 
fectly easy. The inflammation of the muscular or other tissues 
of the back near the situation of the kidneys, does not disturb 
the urinary function more than other diseases. This disease, 
it will be observed^ more commonly affects both sides alike ; 
it may be painful to one in kidney disease to stand on his feet, 
and stoop to take up anything from the ground ; but to one af- 
fected with acute inflammation in the other organs we have 
spoken of, such a motion is still more painful or rather impossi- 
ble. In lumbago, a patient cannot stand on his feet ; or, if he 
does, he would find it impracticable to bend his body forward 
to so great an extent as to reach the ground. Both these dis- 
orders cause pain and numbness which extend down the thigh ; 
but from the kidneys, the pain descends down the inside of the 
thighs, while from lumbago, a similar pain is felt on the outside. 
In certain diseases of the intestinal canal, colic, or local disor- 
ders of a more permanent character, there may be still more 
difficulty in making a proper discrimination. Patient observa- 
tion, and attention to the remote causes, and particularly to 
those causes by which the disease has been immediately exci- 
ted, will commonly enable us to decide this question with suf- 
ficient promptness ; but the obscurity which is so frequently in 



DISEASES OF THE KIDNEYS. 465 

our way, in these cases, should never be forgotten ; and when 
we have made up our minds, and administered our remedies, 
we should not forget to continue the investigation of the nature 
of the disease. 

TREATMENT. 

We are treating of inflammation of the kidney, unconnected 
with the protracted torment of gravel ; and the remedies which 
we shall here offer, are very much the same with those proper 
in other inflammatory disorders. 

Bloodletting is our first, and most important remedy. It is 
advised to use cupping on the loins ; and I have no doubt that 
this is a first rate remedy. Fomentations, with warm applica- 
tions made by large poultices, or flannels dipped into hot wa- 
ter, and changed from time to time, afford great relief from 
pain. Large quantities of warm water thrown up as an injec- 
tion, operate in a similar way, and should be resorted to when 
the pain is extreme. Warm bathing, continued till a conside- 
rable degree of faintness is brought on, may also be resorted 
to ; and here it may be remarked, that these warm applications 
are applied in the most acute inflammation of the kidneys. Ex- 
perience of the great ease they afford, and the safety which re- 
sults from them, have sanctioned their use in this way. 

Cathartics would suggest themselves as important remedies 
in these cases. Care should be taken in the selection of those 
which are used ; those composed of the neutral salts are to be 
avoided, on account of the readiness with which they are taken 
up into the circulation, and thus thrown into the kidneys. Cas- 
tor oil, or a tea of senna, should be preferred. 

The great pain which attends this disease, will call for the 
use of opium, when the circumstances of the case admit of it. 
It should not be used till other remedies have been applied. 
Blood should be first drawn, and the bowels moved by cathar- 
tic remedies ; if the pain then continues, a decided dose of 
opium should be given ; sixty drops of laudanum will perhaps 
answer the purpose, as well as any other form of this remedy. 
This remedy is to be held in hand, and repeated, from time to 
time, as the violence of the symptoms may seem to require ; 
but it should be still borne in mind, that opium is, in these ca- 
ses, a remedy that is rather to be avoided than sought for. 

Diuretics are to be cautiously used in these cases. The 
kinds most proper, are the mildest and least irritating. A tea 
spoonful of spirits of nitre may be given from time to time, if 
30 



466 DISEASES OF THE KIDNEYS. 

the urine is scant and high colored. Carbonate of soda iti do- 
ses of eight or ten grains, may be given under the same rule. 

GRANULAR DISORGANIZATION OF THE KIDNEY BRIGHT's 

DISEASE. 

In the performance of their great office as secretory organs, 
it could not be expected, that the kidneys could always escape 
organic disease. They are, in common with other organs, the 
frequent subjects of disease ; but till of late, these affections 
were covered with almost impenetrable obscurity. Doctor 
Bright, a physician still living, has the credit of first bringing 
these disorders, in a conspicuous point of view, before the 
medical world. The subject is not yet cleared of its obscurity; 
but it would not be right to omit the notice of these disorders in 
this place. 

Examinations after the death of individuals, who have died 
affected with these derangements of the kidney, have led to 
some knowledge of the symptoms which denote their presence. 
The appearances which present themselves are very various. 
Sometimes the kidney is enlarged to three or four times its size 
in health; at other times, it is very much reduced in volume, 
in the one case, it is softened and flabby ; in the other, hard 
and resisting. There are still other appearances worth}' of 
notice. Sometimes the substance of the kidney has the ap- 
pearance of grains, and has been termed granular ; in others, 
the change seems to approach more to disorganization, and a 
blood-shotten and weakened structure are observed. Now, 
all these cases have come under the same name ; and, so far 
as I know, the symptoms which characterise them, have not 
been well ascertained. I think it is not too much to say, that 
the existence of this state of disease in the kidney, cannot be 
considered very certain, till it is developed by dissection. 
But in this, as in a great many other instances, the symptoms 
which attend it, direct to the use of remedies, that are not only 
useful, but, in many instances, perfectly successful. 

Bright' s kidney is a formidable disease. When present, it 
hinders the proper function of the kidneys, detains in the sys- 
tem matters which should be thrown off, or changes them into 
such as are dangerous or poisonous. 

Fever, the general companion of disease, is commonly the 
first signal of the disorder of which we are speaking. Great 
languor, obscure pain in the region of the kidneys, scanty urine, 
nausea and vomiting, attend it in its mildest forms. In its 



DISEASES OF THE KIDNEYS. 467 

more aggravated forms, dropsy follows ; and, in these instan- 
ces, the dropsy is of the most inflammatory kind. Inflamma- 
tions of the most important organs frequently supervene. The 
lungs, the heart, and the peritonaeum, are frequently the sub- 
jects of these attacks. 

There is still a more formidable state of this disease. In 
this, the kidneys fail entirely to perform their office ; no utine 
is discharged. The symptoms at first do not appear so for- 
midable ; but a day or two will hardly elapse, before symp- 
toms of the most awful kind will present themselves. These 
cases are seldom arrested : they are speedily followed by de- 
lirium, or apoplexy and death. 

The presence of this disease is known, or strongly suspect- 
ed, from the qualities of the urine. It is found to contain more 
or less albumen, or that portion of blood which resembles the 
white of an egg. This substance is sometimes so abundant, 
that it is only necessary to raise the urine to a boiling heat, 
when it will be reduced to a whitish substance almost as thick 
as jelly. When the quantity of albumen is less, it will not be 
detected by experiments so rude. 

When the disease has continued for some time, and put on a 
chronic form, the impression it makes on the patient becomes 
striking; the paleness is peculiar; it is dingy, sometimes waxy, 
as it is described. The bowels are usually torpid, sometimes 
the reverse ; but here we must abandon the record of other 
apparently inconsistent symptoms which are spoken of in this 
disease. Till our knowledge of the subject is greater, we must 
content ourselves with the reasonable certainty which the 
symptoms already mentioned give us, that there is present a 
disorganizing disease in the kidneys. 

TREATMENT. 

I have stated that this is an obscure subject, and that the 
exact state and condition of the kidney, is but imperfectly 
known from the symptoms which attend its diseases. The 
remedies for these disorders are fortunately less obscure. The 
decided inflammatory symptoms and plethora ; the oppression 
of the mind and other symptoms, point directly to the active 
depletion which should be adopted. 

Bloodletting should be resorted to without delay, and repeat- 
ed after a day or two, if the symptoms do not give way. Where 
the kidneys seem to be particularly excited, and the pain in 
the loins is considerable, cupping or leeches, will be very im- 



468 GRAVEL IN THE KIDNEY. 

portant ; but blistering should not be used, because in many 
instances the drawing of a blister produces a very great excite- 
ment or inflammation of the kidney of itself. 

Cathartics will form a leading part of the treatment in these 
cases. Take of jalap two drachms, cream of tartar an ounce, 
rub together, and make into eight powders. Of these, give 
one every three hours, till an active cathartic operation is 
brought on. Where symptoms of dropsy are present, this will 
be a very important remedy ; but we shall say more in regard 
to dropsy in another place. A doubt may arise on the use of 
cathartics composed of salts, or even of the cream of tartar, 
we have advised. These articles are readily absorbed, pass 
into the blood, and excite the kidney to a considerable degree ; 
but the copious watery discharges they produce, both by stool 
and urine, are, in the highest degree, beneficial ; so much so 
that any slight excitement they might produce in the kidney at 
the time, is of little consequence. 



GRAVEL IN THE KIDNEY. 

The presence of gravel in the kidney is the most common 
cause of pain and inflammation in that organ. The gravel 
which gives rise to this pain is formed in the kidney, in a cer- 
tain small chamber which is called its pelvis. So long as the 
urine formed in the kidney can pass this gravel without inter- 
ruption, no symptoms of much consequence will arise from it. 
But the gravel will, at some time, fall into the ureter, a very 
small tube through which it cannot pass without causing pain. 
Where the gravel is large, as large for instance as a pea, the 
passage will be so effectually choked up, that the urine will 
pass with the greatest difficulty. Violent pain ensues, with 
nausea, and commonly vomiting. The pain extends common- 
ly from one side of the loins down the thigh, producing retrac- 
tion of the testicle with constantly increasing pain. The grav- 
el is sometimes ragged or pointed in its form, and then the pain 
is exceedingly acute. I have seen such gravel after having 
passed the ureter to the bladder, and thence been discharged 
with the urine, exceedingly ragged and rough, having points 
nearly as sharp as a lancet. 

Gravel is subject to be mistaken for mere inflammation of 
the kidney ; and, in some instances, for colic ; but these mis- 
takes will hardly be made, if a little attention is paid to the rise 



GRAVEL IN THE KIDNEY. 469 

and progress of the disorder. Colic has its premonitory signs, 
the disorder of the stomach and bowels precede the pain ; in- 
flammation will seldom arise without some signs precursory to 
its appearance ; but gravel may occur in a moment, and so 
it does commonly happen, without the slightest previous warn- 
ing of its approach. 

The treatment of an attack of gravel, is but the treatment of 
an ordinary attack of inflammation. Bloodletting and cathar- 
tics should be resorted to promptly ; but they can, at most, but 
moderate the symptoms — the pain will continue till the gravel 
has passed through the ureter into the bladder, or returned to 
the pelvis of the kidney, from whence it came. This last, I 
must think a very rare occurrence. Where the gravel is large, 
it will be proportionably slow in its passage through the ureter ; 
and when it remains at any given point, for a length of time, the 
pain may nearly cease ; but it will be renewed again, as soon 
as the gravel moves. Thus, the patient will be tormented with 
exquisite pain, sometimes for days together; but, at length, the 
gravel will pass into the urinary bladder, and the patient will 
experience sudden and total relief. A few hours commonly 
elapse before its discharge with the urine ; but, with a little 
care and attention, it will be found in the urinal. When dis- 
charged, it will be heard to produce a sharp click at the bottom 
of the vessel. 

Patients are not always so fortunate, as to have the gravel 
w 7 hich has passed into the bladder find its way through the ure- 
thra. When it is retained in the bladder, it may be expected 
to increase in size, and thus form that formidable disorder, 
stone. In some cases, after having grown to a considerable size, 
it finds its way into the urethra, where it passes with great dif- 
ficulty and pain. In a few instances, it stops in the perinaeum, 
where inflammation and ulceration follow; and, after great 
pain and suffering, the stone is extracted through the integu- 
ments ; but, in many more cases, it passes along through the 
urethra till it is finally discharged. In some cases it is so large, 
that it will not pass for many days ; the urine still passing by 
it drop by drop, as forced by the powerful contractions of the 
bladder. W T hile passing in this way, it is easily felt, and might 
be cut down on, and taken out ; but it is very desirable that 
an injury of this kind, should not be done to the parts, and that 
the stone should be allowed to make its own exit. I have seen 
a stone nearly as large as an almond, discharged in this way 
by a boy of twelve or thirteen years of age — having remained 



470 GRAVEL IN THE KIDNEY. 

where it could be plainly felt for nearly a month. No ill con- 
sequence has resulted in this case. 

The great irritation and pain which attend the passage of 
gravel from the kidneys, call for treatment to palliate the symp- 
toms. I have suggested the use of the common means to hin- 
der or lessen the inflammation which may attend these cases ; 
but I have not mentioned the opiates, and diuretics, which 
form, in protracted cases, a necessary part of our remedies. 
Opium may be given, from time to time, to combat excrucia- 
ting pain ; sixty drops of laudanum or three grains of opium 
form a large dose ; and it may be given in less proportion, 
when the symptoms are not extreme. Spirits of nitre may be 
given at the same time, either in combination with laudanum, 
or by itself. A tea spoonful of the spirits of nitre, may be giv- 
en, four or five times a day, if necessary. Where the fever is 
considerable, and the urine highly colored and in small quanti- 
ty, diluted drinks, gum-water, watermelon seed tea, flax seed 
tea, or even cold water, may be beneficially taken, in conside- 
rable quantities. 

Patients who have gone through one attack of gravel, or 
have by passing small gravel found that they were liable to be 
affected with this disease, should go into the best investigation 
they can have made of the nature of the disease with which 
they are affected, and use all the means which art affords for 
relieving themselves from so great an evil. 

The gravel which is most commonly met with is of two kinds, 
that which is most common and least dangerous, has been term- 
ed red gravel ; it commonly forms in the urine after it has been 
discharged, when it crystalizes in the bottom of the vessel, in 
small reddish colored grains like sand. These crystals are of 
lithic acid, and remain dissolved while the urine is warm and 
in the body ; but, like many salts held in solution by a warm 
fluid, crystalize when the fluid becomes cool. It is surprising 
to see the quantity of this gravel which is sometimes found in 
the urine of a single person. Some have been known to dis- 
charge it in such quantity, that it was thought to be an easy 
matter to have obtained even a peck of such sand. Now this 
gravel is of itself attended with but little danger ; for it seldom 
forms in the bladder or kidney, and rarely produces a painful 
attack of gravel or stone. 

The gravel which results most frequently in the formation 
of stone in the bladder, differs very much from that which I 
have been describing. It forms in the bladder, or in the kid- 
ney, and seems after it has found some nucleus or small p)in& 



GRAVEL IN THE KIDNEY 



471 



to begin on, to be deposited in layers, increasing the size of this 
body from time to time. The variety of these concretions is 
very great ; and it would be useless to undertake to consider 
them here. It may be observed, however, that the white grav- 
el is dependent on phosphorus for its peculiarities, and is abun- 
dantly more dangerous than the red gravel I have described ; 
but the stone which has acquired considerable size, is some- 
times found composed of layers first of white, and then of red 
gravel, sometimes grown or enlarged to weigh several ounces. 
In the treatment, it is fortunate that both cases are attended 
with acid urine, and are benefited by the same remedies. 

Alkalies combine readily with most acids, and form solu- 
ble neutral salts. Chemistry would therefore naturally look to 
these bodies as a remedy for gravel. For the common red 
gravel, soda is a good remedy ; from five to twenty grains at a 
dose, may be given in water three times a day. It should not 
be given so largely as to make the urine itself akaline ; but this 
is not always a point very easily decided, and the doses I have 
advised may be lessened or increased, according to the idea 
entertained of more or less acid in the urine. 

Potash, although less convenient, and less agreeable to the 
taste, has some advantage over soda, in the treatment of some 
cases of this disease. Soda, it is stated, sometimes unites with 
the urine in cases of white gravel, and forms of itself an insol- 
uble salt, which may form a dangerous deposit from the urine. 
From potash we are not exposed to this danger. For, so far 
as the laborious investigations which have been made of this sub- 
ject inform us, potash never becomes a part of an insoluble 
compound in the urine. It is, therefore, the safest remedy in 
gravel. It may be given in doses of from five to ten grains, 
two or three times a day, for a great length of time. It should 
be kept in solution. Take half an ounce of carbonate of potash, 
or salasratus dissolved in four ounces of water, and take a tea 
spoonful in water, two or three times a day before meals. 

It may be well to mention, that a stone or calculus frequent- 
ly met with and differing from those I have mentioned, has for 
its base the oxalic acid ; it has been denominated the mulber- 
ry calculus, and has, when extracted, a considerable resem- 
blance to several black mulberries bound together. In its 
treatment, it does not materially differ from other cases ; but 
when the urine is found to contain this acid, articles containing 
it should be studiously avoided. Rhubarb, which forms a fa- 
vorite pie, owes its peculiar flavor to oxalic acid ; it is, there- 
fore, not to be used by these patients as an article of food. 



472 DIABETES. 

It is said that prevention is better than cure ; and this would 
seem to apply with full force to calculus disorders of the uri- 
nary organs. Red gravel is the child of intemperance and ex- 
cess ; it is the scourge of ale drinking, beer drinking, and wine 
drinking ; it is the scourge also of excesses in eating ; and, in 
all cases, the habits of the patients in regard to these things, 
should be brought under proper restraint. But there are many 
cases in which persons who are by no means addicted to ex- 
cesses of any kind, have attacks of this disorder. 

Phosphatic, or white gravel, and all those on which the pres- 
ence of stone depends, occur with more obscure remote causes. 
These cases are frequently met with in children, who have 
stone, even before they are seven years old. In these cases no 
charge of intemperance in drinking can justly be made ; nor 
do I know that intemperance in eating has been charged on 
these little sufferers. Nor is the disorder confined to child- 
hood ; persons of all ages, sexes, and conditions, are liable to 
it. It is much more frequent in some countries than in others, 
without regard, it would seem, to the habits of the people. In 
the United States, I think it more common in districts where 
the people use hard water, or water containing in solution a 
portion of lime. 

Debility has been mentioned as the sole circumstance or 
cause of that state of health, which exposes persons to the de- 
posite of these calculi. It is hardly necessary to say, that this 
is a very vague and uncertain reason to assign for a thing so 
peculiar. It is useful only as a direction for us, in patients 
who have shown symptoms of gravel. These we may well 
consider as being affected with a dangerous debility. They 
should be treated with tonics — muriate of iron, sulphuric acid, 
tincture of gentian, or other strengthening remedies. Nor 
should a rich and generous food be denied them ; for although 
excesses in eating and drinking may have caused debility, 
strength is not to be obtained by living too poor. 



DIABETES— EXCESSIVE DISCHARGE OF URINE. 

Every one is apprised, that the quantity of urine discharged 
jn a given time, varies under different circumstances ; and that 
it may be very much increased or diminished, without any ap- 
parent loss of health. Individuals differ very much from each 



DIABETES. 473 

other in this respect, some will discharge a great deal more 
than others. The quantity discharged, does not always de- 
pend on the amount of fluid taken into the body ; but this cir- 
cumstance must have more or less control of the amount dis- 
charged by way of urine. Some persons, in apparently good 
health, contract the habit of drinking enormous quantities of 
water ; and these, without apparent disease, discharge equally 
enormous quantities of urine. Where fermented liquors are 
used as a beverage, especially strong beer and porter, the 
amount drunk is sometimes enormous ; rising, it is said, in 
some instances, to three gallons a day, or upwards. Yet such 
persons pass for healthful. Remedies will hardly be thought 
necessary for a mere increase in the quantity of urine dis- 
charged, when this is brought about by the obvious causes I 
have mentioned ; yet physicians are not unfrequently consult- 
ed b\ T those who are frequently disturbed at night, by the ne- 
cessity of having to rise from the bed to pass urine. Con- 
sidering themselves diseased, and overlooking its obvious 
cause, the excessive amounts of the drink they take, such 
persons apply to physicians for a remed}'. The only remedy 
requisite, is to abstain from the causes of this disturbance. 
Such persons should reduce the quantity of fluids they take, to 
the ordinary standard of healthy persons, and the symptoms of 
excessive urination will disappear. If the disorder has con- 
tinued for a considerable length of time, and especially if the 
person is old, which is very apt to be the case, the use of tonic 
medicines will be beneficial. Warm clothing to protect the 
skin from cold, and sometimes an anodyne at night, are all the 
remedies which it appears necessary to suggest. 

DIABETES MELLITUS. 

This disorder, although not very uncommon, has not acquir- 
ed, so far as 1 know, a popular or common name. It consists 
in the discharge of enormous quantities of sweetish urine. It 
is a formidable disease, and evinces a total derangement of the 
health of the patient, or of the function of the kidneys. 

The disease is exceedinly insidious in its attack. The per- 
spiration of the body is very much lessened or suppressed — 
the appetite becomes enormous, and the urine exceedingly co- 
pious, being discharged frequently by day and by night. The 
thirst is considerable, more or less fever commonly present, the 
powers of the system give way, with loss of strength, loss of 
virility, marasmus, and complete exhaustion. 



474 DIABETES. 

The urine is variable in its color, commonly pale, sometimes 
straw color, and sometimes greenish, with a smell less like urine 
than anything else ; it has been compared to the smell of hay. 
The composition of the urine varies also. Sometimes it contains 
chyle, and sometimes sugar ; but, in either event, the quantity 
of solid matter abstracted from the system daily in the urine, 
is enormous. By simply evaporating the urine which has 
been discharged in a single day, from a pound, to a pound and 
a quarter of solid matter, has been found. A waste so conside- 
rable may readily account for the loss of flesh, so commonly 
experienced in this disease. 

The enormous quantity of fluid discharged in this disease, 
and the great amount of solid matter contained in it, have led 
to a great deal of investigation of its nature. It has been found, 
that in many instances, the fluid and solid matter thus dis- 
charged, exceed the whole amount of solids and fluids taken 
in ; and this excess has been found to continue for a considera- 
ble length of time. The patients, however, are under these 
circumstances constantly growing worse. 

Great disorderof other functions is found to exist, during the 
continuance of this disease. The bowels are constantly cos- 
tive ; the fasces discharged are without fetor, and resemble 
that of a goat, more than that of a man. The disease progres- 
ses slowly, frequently seems to induce consumption, jaundice, 
or tyhus fever, and, in some instances, ends in dropsy. 

TREATMENT- 

Diabetes resembles so closely a common dyspepsia, that 
many physicians have considered it but a variety of that dis- 
ease. In its onset, it is usually quite inflammatoiy, and should 
be treated by bloodletting and active cathartics ; but these 
remedies cannot be persisted in, for a great length of time. 
Opium has been recommended ; and certainly, to allay the ir- 
ritation produced in the kidneys by this disease, and to restore 
the secretions from the skin, no remedy would seem to promise 
more. 

I have met but a single case of diabetes in my practice ; 
and this was cured by a rigid observance of a low regimen, and 
the daily use of antimonial mixture, made by putting two 
grains of tartar emetic, and a drachm of nitre into half a pint of 
water. Half an ounce, or a large table spoonful of this mix- 
ture was taken from four to six times a day. No other reme- 



DIABETES. 475 

dy was used in this case. The thirst speedily abated, the ap- 
petite became easily controlled — the patient was young, and 
recovered in a few weeks. Yet I am far from thinking that 
this course will cure every case, although I think the pre- 
scription very much to be relied on. 

A rigid regimen has been properly regarded as the founda- 
tion of a proper treatment in diabetes. Articles containing 
starch or sugar, should be but sparingly used ; for, although 
these articles are easily digested, they furnish abundance of 
that saccharine matter, which the kidney, in this disease, seems 
so prone to extract from the blood. Animal food has therefore 
been recommended, to the exclusion of almost every other. 
In this, as in other cases, where chemistry seems to point out 
the remedies used in medicine, the maxim should be adopted 
with great allowance ; for the powers of life have a control of 
this subject, which as yet, has not been fully explained. I 
should not forbid my patient a morsel of bread, and in spite of 
all an erring chemical system of prescriptions may signify to 
the contrary, I should make up the daily fare of my patient out 
of the common articles of food ; I should allow him, meat, 
bread, rice, milk, and even sugar ; but all these in quantities 
exceedingly light, for although emaciation and wasting, even 
to the point of death be present, there can be no good in urging 
on the patient more food than can, by his powers, be perfectly 
digested and assimilated. The quantity of food allowed in 
these cases, should be small ; one fourth, or even less than one 
fourth, of what the same person might take if in health. 

There is a form of diabetes which I have never witnessed, 
in which it is said the urine coagulates, forming a milky or 
clabber-like jelly. After standing a length of time, a matter 
resembling cream will be found at the bottom. I have found 
nothing in my practice resembling this, except that, in teething 
children, I have frequently seen a cream-like deposite strictly 
resembling that which I have seen described as belonging to 
this disease. 

The treatment of this form of diabetes, is said to be not very 
well defined ; but it is less dangerous than other forms of 
this disease. The cases I have met with in children, have not 
proved particularly dangerous ; and, with the ordinary treat- 
ment of the dyspepsia usually attending it, such cases have 
terminated favorably. If I should meet a case of this kind in 
a grown person, I should treat it as a general dyspepsia; ta- 
king special care to place the patient under a very low regi- 
men. 



476 DROPSY 



DROPSY. 

Dropsy produces the effusion of a watery fluid into the cel- 
lular membrane, or into the natural cavities of the body. There 
are, besides these cases, some which are termed encysted, from 
being local in their character, commonly unattended with gener- 
al disease, and affecting very small portions of the body. The 
scrotum, or sack containing the testicles in men, and the ova- 
rium in females, are the most frequent seats of this variety of 
dropsy. Dropsy of the brain is also a local disease, being 
scarcely ever attended with symptoms of general dropsy. The 
dropsies which occur in other cavities, such as the abdomen, or 
lungs, or the pericardium, which surrounds the heart, are more 
frequently attended with a general dropsical diathesis, and 
commence with, or terminate in a general dropsy. 

Much has been written on the subject of dropsy ; but very 
vague notions were entertained of its causes, till very lately. 
The discovery of the lymphatic vessels, with their important 
function of absorbing and returning to the circulation the fluid 
parts of the blood, soon called the attention of medical writers 
to their probable connexion with dropsical effusions. Doctor 
Darwin, reasoning from the few facts that were then known, 
placed dropsy on a beautiful system of cause and effect. He 
saw in these cases, only diseased lymphatic vessels, and their 
failure to perform their office of absorption. Later writers have 
demonstrated that the excess of exhalation, or throwing off, of 
fluids from the blood, may also be a cause of this disease; and 
it may be considered as an established fact, that from one or 
both of these causes, the disease we are considering does com- 
monly arise. Through life there is a constant process of exha- 
lation of the fluid parts of the blood, on the skin, and through- 
out the whole internal structure of the body. This exhalation 
is balanced by the absorption of so much of this fluid, as ought 
to be returned to the blood, not only by the veins, but by a pe- 
culiar set of vessels formed for that purpose. In dropsy, the 
healthful relation between these two processes is broken ; and 
the fluid which is no longer taken up and properly disposed of, 
is permitted to accumulate, to oppress and to destroy the or- 
gans in which it occurs, or the life of the individual who is thus 
affected. 

The fluid which is thus thrown out in dropsy, is by no means 
uniform in its appearance. It is composed principally of the 



DROPSY. 477 

serous, or watery portion of the blood ; but in some instances, 
especially in the dropsy of cavities, such as the abdomen, it 
sometimes contains albumen in sufficient quantity to give it the 
appearance of jelly. 

Dropsy is sometimes a primary disease, and pervades the 
whole system. The flesh becomes suffused with water, which 
descends through the meshes of the adipose or fatty membrane 
to the most dependent parts. The feet are first noticed to be 
swollen, in these cases ; and, as the disorder increases, the 
swelling ascends to the body. No particular organ seems to 
suffer more in these cases, than another \ and even when death 
has occurred, the organic lesions so commonly met with in this 
disease, are wholly wanting. But by far the greater number 
of dropsies, arise from diseases of particular organs. Enlarge- 
ments or diseases of the liver, produce not only a dropsy of the 
abdomen, but result in general dropsies ; affections of the lungs 
often terminate in the same way ; and it may be considered as 
a general truth, that whenever, from the enlargement or swel- 
ling of any organ, pressure is made on the veins in their course 
to the heart, dropsy may occur from that cause alone. 

The character of the disease, or fever which attends dropsy, 
is a matter of prime consideration in its treatment. The first 
idea that would strike any one on looking at a patient in this 
disease, would be, that there was present a great and alarming 
state of debility. For this debility, we should naturally look 
into the class of stimulants and tonics for a remedy ; and such 
has been the treatment of this disease in thousands of instan- 
ces. But reason and experience have taught us that dropsy, 
although attended with great weakness, is a disease of a high 
inflammatory character, and is to be successfully treated by 
remedies, active and depleting, in a high degree. It is true, 
there are exceptions to this rule, but they are rare, and not to 
be trusted, except where the general prostration of the system 
is too obvious to admit of any question. This state of things 
seldom occurs till the patient has been reduced by the most ac- 
tive treatment. 

ANASARCA GENERAL DROPSY. 

This is a general disease, affecting the system in such a manner, 
as to cause the throwing out of the serous portion of the blood, 
and its accumulation in the adipose, or fat containing tissues of 
the body. When it is unattended with any local disease, it is 
still in a high degree inflammatory ; the pulse will be found 



478 DROPSY. 

hard, but rather slow, a great degree of lassitude and heaviness 
will be experienced, but the appetite is rather increarsed than 
impaired. It sometimes occurs to persons who were previous- 
ly in high health ; but this is not so common. It usually at- 
tacks the weak and the invalid, and is known to exist by the 
swelling, especially of the feet, which forms its first and undis- 
puted symptom. This swelling is easily distinguished from 
every other. By pressing on it gradually with the finger, the 
water of the part is removed, and a depression, or pit is left, 
which will gradually disappear when the pressure is removed. 
The skin is dry, and although, at sometime of the day, there is 
heat and burning of the hands and feet, the extremities, when 
examined, commonly feel cool, if not cold. The urine is, at 
the same time, scanty and red, sometimes tinged with bile. 

General dropsy frequently arises from causes which seem to 
operate locally, especially such as operate on the lungs. Scar- 
let fever is not an uncommon cause of a dropsy of this descrip- 
tion. This so frequently occurs, that it is looked for as a com- 
mon occurrence, in persons who seem to have recovered from 
that disease. Measles also seem to produce the disease in the 
same way, and very much of the same character; but these 
cases are rare. Other fevers also terminate in the same way. 
I have seen many cases succeed bilious fever, especially when 
that disease was protracted in the form of an intermittent. 

Diseases of the skin also sometimes produce general dropsy. 
Nettle rash, a very common disorder, sometimes results in this 
way; but it is principally from those forms of disease produc- 
ing pustules on the skin, that dropsy is to be apprehended. 
Some of these diseases which are chronic, and exceedingly 
troublesome ; when repelled by powerful astringent remedies, 
have resulted in dangerous attacks of general dropsy. 

Suppressed discharges have also a tendency to produce 
dropsy. The habitual discharge of blood from piles, excessive 
menstruation, or other similar discharges of blood which have 
continued for a considerable time, are not suddenly arrested 
without the danger of a supervening dropsy. In like manner, 
diarrhoea, when it has been obstinate, and continued for a length 
of time, produces a dangerous tendency to a general dropsy. 

REMEDIES. 

The most powerful cathartic medicines have been found of 
most use in discharging from the system the water of dropsy. 
I advise in preference to any other, jalap and cream of tartar. 



DROPSY. 479 

Take of jalap a drachm, cream of tartar an ounce, divide into 
tour powders, give one in water, every three hours, till a pow- 
erful cathartic operation is brought on. Used in this way, it 
will be seldom necessary to give anything to check its opera- 
tion. The patient will be found to rise from every discharge, 
with the sense of improved strength. But, should the remedy 
be used at a late period in the disease, or, from some particular 
reason, the patient prove unable to bear its action, and grow 
faint, its further operation may be checked by twenty drops 
of laudanum, repeated if necessary. This cathartic which I 
consider by far the most important in the treatment of general 
dropsy, when the disease is not attended with particular local 
disorder, may be repeated every second or third day, till the 
swelling subsides. 

Other cathartic medicines may be used, when, from debility 
or other reasons, the cream of tartar and jalap are thought to 
be too active. Senna and salts are perhaps the best of these. 
But in general such remedies as produce copious watery dis- 
charges from the bowels, are proper in these cases. I have 
not advised elaterium, not that I doubt its great powers, but 
that its activity is so great that it is barely proper to leave it out 
of the class of poisons. I have never used it, but do not doubt 
the great benefits that have been derived from it, in untracea- 
ble cases of dropsy. 

Bloodletting is by no means to be neglected in this disease ; 
if the pulse is full and hard, the tongue white and coated, and 
considerable symptoms of fever present. Blood should be 
drawn from the arm, although the pallid look, and the debility 
of the patient might seem to forbid it. In a disease like drop- 
sy, which requires the use of such active depleting remedies, 
it would be wrong to suppose the patient cannot bear the ab- 
straction of blood. The remark of Doctor Rush, that blood- 
letting is safe where cathartics, from their depleting effects, are 
dangerous, I have verified in dropsy. I have, in some cases, 
found the abstraction of blood less exhausting, while at the 
same time it proved itself a more efficient remedy for the re- 
moval of the disease, than cathartics. 

By these remedies, we shall almost always be enabled to re- 
duce the swelling attendant on dropsy. The great question 
now arises, how is its return to be hindered. Diuretics of vari- 
ous kinds have been used from the earliest times. Squills and 
digitalis are most frequently used, at the present time. Squills 
should be used in combination with calomel. Take ten grains 
of calomel, and sixty grains of squills, make them into twenty- 



4S0 DROPSY. 

four pills. Of these, three a day may be given, and be con- 
tinued, according to the necessity of the case. This course is 
to be adopted before the dropsical swelling has entirely disap- 
peared, and continued as long as any of the swelling remains. 
If the case proves obstinate, and the pills are continued for a 
week or two, a salivation will probably come on ; and this is 
often found the signal for the disappearance of all the dropsical 
symptoms. In dropsies, salivation is apt to prove exceedingly 
painful, and is very much objected to by patients ; but if the 
remedy does not remove the disease before a salivation is in- 
duced by it, there should be no hesitation in pressing it still 
farther. In addition to the pills recommended, a dose of ten 
grains of calomel should be given, and be repeated once in 
three or four days, if necessary. For no patient should con- 
sider himself as having tested the benefits of calomel, till some 
degree of salivation has made its appearance. 

In spite of these means, dropsy will frequently prove obsti- 
nate, and return in the face of all our efforts ; and we are 
thrown on the necessity of using remedies which may be borne 
for a greater length of time, without exhausting and utterly de- 
stining our patients. The antimonial mixture, so often recom- 
mended, to reduce inflammatory action and restore the secre- 
tions, finds its place here. I advise a greater proportion of ni- 
tre, combined with tartar emetic. Take half an ounce of nitre 
(salt petre,) and two grains of tartar emetic ; dissolve in half a 
pint of water, and give a table spoonful, once in four hours. If 
it proves emetic, lessen the dose ; but continue it in such quan- 
tity as the stomach will bear, for many days together, if the 
symptoms still seem to demand it. If it produces a moist 
skin, lessened thirst, and manifest increase of urine, faith in its 
benefits should be firm. 

The alkalies have been much recommended as diuretics, in 
this disease. Carbonate of soda is the most convenient of 
these, and may be given in doses of fifteen grains, repeated 
three or four times a day, especially after meals. Carbonate 
of potash may be given in the same dose under the same regu- 
lations. Calcined magnesia, being a mild cathartic, may be 
substituted, when some degree of cathartic effect is desirable. 
It is beneficially combined with rhubarb. Take a drachm 
each, of the rhubarb and calcined magnesia, rub them together, 
and divide into four powders ; one may be given after eating, 
and repeated, if it does not move the bowels in four or five 
hours. 

Dropsy is often complicated with other disorders, and some- 



DitorsY. 4S1 

times with diarrhoea, which would appear least of all to be ex- 
pected. The cathartic course we have recommended would 
seem to be wholly inapplicable in these cases ; and it may be 
considered prudent to forbear the use of them. Bloodletting 
has been found peculiarly applicable to these cases. The di- 
arrhoea has given way, and without much reliance on cathartic 
medicines ; the diuretics, calomel and squills and nitre, have 
brought such cases to a favorable termination. 

I have omitted to state the particular objects of digitalis, and 
the manner of using it ; I have not found it as efficient as its 
reputation had led me to expect. Should the remedies I have 
advised not prove effectual, this powerful remedy should not 
be neglected. Give twenty drops of the tincture of digitalis 
every three hours, till from the nausea it produces, it is thought 
prudent to suspend it. It is said in these cases to reduce the 
pulse and promote discharges by urine, in a remarkable de- 
gree ; and such effects I have seen arise from it. If it is taken 
up as a remedy, it should be diligently attended to — given un- 
til its effects are obvious and sufficient, and then suspended ; 
to be returned to again after a few days, if necessary. If, af- 
ter the use of such remedies as I have described, patients be- 
come exhausted, and the swelling returns again and again, 
sudorifics, or sweating remedies, may be used with the hap- 
piest effects. After having caused a discharge of the w T ater, 
and the reduction of the patient to the appearance almost of a 
skeleton, and having proved by repeated trials, that the active 
remedies used could not be suspended without a return of the 
swelling, I have given Dover's powder, fifteen giains, some- 
times even a larger dose, twice in twenty-four hours, with the 
happiest results. I have found this remedy to produce a copi- 
ous discharge from the skin, by which the return of the swel- 
ling was entirely arrested, while by diet a little improved, the 
patient would acquire strength, so that the remedy could be 
dispensed with in a few days. I have thus performed some of 
the most remarkable and perfect cures of dropsy, which it has 
ever occurred to me to witness. 

When the swelling of the limbs refuses to yield to other 
remedies, it has been advised to puncture them, and let the se- 
rum thus flow from the body. It is only in extreme cases that 
this course can be justified ; but it is a remedy plainly pointed 
to by nature, for the skin often bursts of itself, and the whole 
of the serum which had accumulated is speedily discharged. 
Nor is this rude operation of nature always attended with a fa- 
tal result ; the patient will sometimes recover, even in cases 
31 



482 DROPSY. 

which appear the most unpromising. I attended a few years 
ago, a lady of more than seventy years of age, who, in a state 
of general dropsy, which had distended the limbs to the point 
of bursting, experienced this fracture of the skin of both legs ; 
the water of dropsy flowed from them for months ; and, by 
the powers of nature almost unaided by remedies, (for dispair 
had brought her to a point to refuse or disregard them) she 
gradually arose to a good degree of health, which she still en- 

It is by no means desirable to puncture the limbs for the 
discharge of dropsical effusions. Such punctures are some- 
times followed by mortification, and a speedy dissolution. If 
they are made, they should not be made too near the extremi- 
ties, but in a dependant point, somewhere near the calf of the 
leg. A puncture of some depth, made by a needle, should first 
be tried. If the water flows, drop by drop, it is sufficient ; if 
it stops, the operation may be repeated, or a very narrow 
opening made by a lancet. No dressings need be applied. 

Bandages applied to the limbs, have been recommended as 
a means of averting the necessity of their being punctured, or 
the danger of spontaneously bursting. I have used them with 
some advantage ; but it is to be remembered, that they are at 
best a mere palliative of a single inconvenience, and not to be 
relied on as a general remedy. 

Dropsy, which is too frequently brought on by excess in eat- 
ing and drinking, is not to be cured without abstinence, ad- 
hered to with the greatest diligence and perseverance. I nev- 
er knew a worse case of dropsy than one in which the state of 
the stomach rendered it almost impossible to give any active 
medicine ; for every thing of the kind was thrown up, as soon 
as it was swallowed ; yet a perfect cure of this case, was ef- 
fected by abstinence alone. A single cup of tea, with half a 
biscuit, which could not have weighed two ounces, was taken 
evening and morning ; and neither food nor drink of any kind 
beside this, was taken for three months. The patient was a 
lady, forty years old, or upwards ; she kept her bed during 
this slow cure, without rising from it, except for a moment at 
a time ; and thus, as it were, vegetated into perfect health. 
Her flesh and complexion resembled those of a babe of six 
months old, more than any thing else. It is not necessary to 
say much on the regimen proper in dropsy ; it is to be low and 
scant, to the last degree ; it is to be as restricted in drinks, as 
it is in solids ; although, in the first stage of inflammatory ca- 
ses, there may be for a time, some exception made in favor of 



DROPSY. 4S3 

drinks. It is impossible to assign rules which shall be without 
exception, in these cases. I would say that both food and 
drink should be reduced to the one fourth part of what would 
be necessary in health ; and that the articles should be those 
least stimulating. I am apprised that this restriction in drink 
is no longer a maxim in the treatment of dropsy ; but I have 
found the patient's thirst a very erroneous criterion for the use 
of fluids. Drinks are not to be forbidden while the fever is 
high ; but as soon as the symptoms of inflammation abate, a 
morbid appetite for water is to be controled with the same care, 
that a morbid appetite for food would require. 1 will add, that 
I have often seen a violent thirst follow the copious discharge 
of fluids by cathartics ; and the indulgence in drinking copi- 
ously, followed by a sudden increase of dropsical swellings. 
In these cases I have seen abstinence from drink of great ser- 
vice ; the thirst giving way of itself in a short time. 

Almost every disease, runs at last down to a point of de- 
bility, from which our patients require the use of tonics and 
nutritious food, to raise them. This point arises also in drop- 
sy ; but it is impossible to give any rule by which its presence 
may be absolutely known. The preparations of iron have been 
most used in these cases. They are most needed when from 
the long continuance of the disease, and the great change 
which has happened in the character of the blood, the peculiar 
action of this remedy becomes necessary. It is not alwaj'S 
safe to wait until the dropsical swellings have entirely disap- 
peared. The remedies may be tried, and the judgement form- 
ed of their benefits by a little observation. The common car- 
bonate of iron or red precipitated carbonate, are, as I think, 
the more convenient remedies. They should be given in de- 
cided doses, ten to fifteen grains in powder mixed in a little 
syrup, may be taken twice a day. The muriated tincture of 
iron is also a good remedy, and may be taken in water, ten or 
fifteen drops, two or three times a day. At the same time a 
more generous diet is to be allowed. The patient will com- 
monly take readily enough any food which is allowed him ; 
and the quantity, when the tonic remedies we have described 
are required, may be increased; perhaps doubled beneficially. 
It is unnecessary to go into further details of the means of re- 
storing patients from the great prostration, which commonly re- 
sults from dropsy. There is nothing peculiar in these cases, 
and a single caution only is necessary, and that is, not to re- 
turn too soon to the use of nutritious food, and tonic medi- 
cines. 



4S4 DROPSY 

A few more words, and we shall have done with the subject 
of general dropsy. It is obvious from the circumstances under 
which dropsical effusions occur, that it will be commonly pres- 
ent at the fatal termination of several organic diseases. But 
we are not therefore to despair in every lingering case of drop- 
sy; for the local disorders on which some of these cases de- 
pend, may give way ; and when the disease has arisen without 
any connexion with local disorder, it terminates favorably in 
many cases in which there would have appeared to be scarce- 
ly a ray of hope. These successful terminations in desperate 
cases often happen under the use of remedies of a very low 
degree of medical activity. The circumstances under which 
such escapes from imminent danger have occurred, have been 
so striking, that I have been bound to acknowledge the favora- 
ble influence of remedies which appear to promise the least. 
I witnessed a case of recovery, from the use of black oxide of 
iron, after the most active treatment from more powerful reme- 
dies had been used in vain. A lady, apparently in her last 
week of existence from general dropsy, was advised by one of 
the lowest pretenders in medicine, to use iron scales. He pro- 
cured the remedy by heating to redness, in a lightwood fire, 
an old firying pan. Allowing it to cool down from the red heat 
it had been exposed to, the scales which were formed on its 
surface were taken and reduced to powder. A tea spoonful of 
this powder was administered in syrup, at a dose ; violent 
vomiting followed the first administration. A second portion, 
given a few hours after, proved an active cathartic, producing 
copious watery discharges, with immediate and great relief. 
These doses were repeated from time to time, with similar re- 
sults, and by continuing the remedy, for about two months, the 
patient recovered to a state of perfect health. Now I do not 
recommend this remedy with the confidence which this case 
might seem to inspire, for I have tried it again and again, in 
other cases which appeared to me similar, without experienc- 
ing from it such remarkable results. But the influence of this 
case on my mind has not been lost. I do not fail to change 
my remedies, when cases of dropsy prove obstinate. I have 
found many cases yield to inferior remedies, after having re- 
sisted those more powerful. And it may be prdperly set down 
as a rule of practice in dropsy, that remedies are to be chang- 
ed for others, when they are not obviously beneficial; and I 
would add, that in cases which are to all appearance despe- 
rate, it is wrong to give up in despair, and cease to use reme- 
dies. 



DISEASES OF THE NERVOUS SYSTEM 485 

Since writing the above, I have fallen on the remark of Dr. 
Darwell, that in the present state of medical science, it is be- 
coming an axiom "to allow dropsical patients as much fluid as 
they wish to drink." 

It is not every alteration which is an improvement, in either art 
or science, and this disregard to all restriction of fluid to drop- 
sical patients, I think exceedingly pernicious. A ravenous and 
indiscriminate appetite for food and drink, is a common atten- 
dant on dropsy; and [ have found both thirst and appetite 
greatly increased after the brisk and efficient operation of a 
water discharging cathartic. The thirst, especially, comes on 
immediately after copious discharges, either by stool or urine. 
This thirst is temporary ; and if the patient will forbear to 
drink, he will cease to desire it after a few hours. This fact 
is often important to be observed. Thirst depends on the ab- 
sence of fluid in the stomach; and this absence is supplied by 
the natural secretions of the parts, when time is allowed for it. 
Every one may test this by forbearing to drink after a hearty 
meal ; he will find that the thirst will be temporary. But 
whether I have given the proper reason for this fact, is a mat- 
ter of little consequence. I rest the rule I offer on experience 
and observation. The appetite for water is no more to be 
trusted in dropsy than the appetite for food. It is not so fre- 
quently ravenous and insatiable ; but, in some cases, it is ex- 
treme, when a very small quantity of fluid is proper. 



DISEASES OF THE NERVOUS SYSTEM— NEUROSES. 

The brain is the organ of thought ; the nerves are the organs 
of sensation ; and the muscles are the organs of motion. The 
diseases which have been called nervous, affect those organs, 
without producing any disorganization which can be detected 
by the anatomist. They are acknowledged to be, the least un- 
derstood uf all the disorders affecting the body. 

The obscurity which rests on these subjects, depends in 
part on our inability to perceive in the structure of the parts, 
or the substances composing them, any fitness for the produc- 
tion of their effects. We see noihing in the form or structure 
of the brain, which will inform us that it is the centre of all our 
sensations ; we see nothing in the nerves from which we can 
infer that they are the organs through which the cause, of our 
sensations and voluntary motions are transmitted ; and we see 



EPILEPSY. 

as little in the muscles, which shall inform us of the astonish- 
ing manner in which they are brought into use by the will. 
All these powers and capacities of these organs we learn from 
experience and observation ; and after all the thought, and ob- 
servation which the subject has drawn forth, we are as igno- 
rant of the mysterious connexion of mind and matter, as on 
the day the investigation began. 

Another source of difficulty in the investigation of this sub- 
ject, arises from the complication of nervous diseases, with 
those of a different character. Tetanus, which in some instan- 
ces arises spontaneously, and destroys life without leaving a 
trace of local injury ; is in others, brought on by wounds or 
great injuries inflicted on the body. Epilepsy which occurs 
in persons with malformation of the brain or deformity of the 
skull, occurs also where these organs show the highest and 
most perfect development. The relation of cause and effect 
is in these cases too obscure for our comprehension, and we 
give its investigation over as a hopeless task. 

The number and variety of these diseases are considerable ; 
some of them are the most hopeless and painful of all those 
with which men are afflicted ; but others are so void of danger, 
as to obtain for the sufferer a very small amount of sympathy. 
But the pain and misery they cause are far greater, than those 
which arise from other diseases. It matters not what others 
may say or think ; the person afflicted with a nervous disease 
is always unhappy ; to him the matter is always important. 
Nor is the pre-eminence of human suffering greater in the less 
fatal forms of nervous disease, than in the more dangerous. 
The forebodings of the hypochondriac are nothing to the fixed 
and silent melancholy of the epileptic ; and if the form and 
expression of deep despair are to be painted, tetanus or hy- 
drophobia will furnish the most perfect original. 



EPILEPSY. 

This disease is very common, and if not hereditary in some 
families, is peculiarly liable to occur to persons of a particular 
temperament and organization. It is not always easy to as- 
sign any cause for it; as it frequently occurs to those who had 
been in the enjo}<ment of uninterrupted health. It is said to be 
more frequent in women than in men. Its attack is commonly 
during childhood, most frequently between the ages often and 



EPILEPSY. 



487 



twenty years ; but it appears that all ages are liable to suffer 
this peculiar affliction. Nothing can differ more in its effects 
than different cases of this disease ; some persons being subject 
to it for many years without very great detriment to health, 
while in others it proves destructive of life in a short time. 
Equally great are the varieties of its influence on the mind ; 
in some instances it proves truly destructive of the mental fac- 
ulties, while in others if it has not increased, it certainly has 
not injured them. All the world are apprised that Julius Cae- 
sar, Mohammed, and Napoleon, w r ere sufferers by this disease. 

The causes which have appeared to induce attacks of epi- 
lepsy, are not such as to enable us to point them out with much 
advantage towards the prevention of the disease. They are 
chiefly such as relate to affections of the mind. Violent pas- 
sion, sudden fear, or intense excitement of any kind has fre- 
quently produced the first attack of this disease. In other in- 
stances affecting the body, a debauch in eating, a blow on the 
head, or other injuries seem to have led to the same result. 
Worms, undigested food in the intestinal canal, an overloaded 
state of the bowels, and a great many other things of like kind, 
have been mentioned as inducing a first attack. 

It is not always that an attack of convulsions in the ordina- 
ry form of epileptic fits, will be followed by a return of the 
disease. Where convulsions are brought on by any violent 
disorder, such as bilious fever, measles, or small-pox, the dis- 
ease is not subject to return again, except the person had a 
strong predisposition to it. Even a spontaneous attack which 
had not been preceded by any disease, is frequently recovered 
from without establishing that unfortunate habit, which may 
lead to the establishment of the disease during life. 

The prognosis in epilepsy, is generally unfavorable ; the 
disease usually pursuing its course without being arrested by 
remedies. The violence of the symptoms would lead us to 
expect fatal injury to the brain, and to the organs concerned 
in the circulation of the blood ; and in some instances this ap- 
pears to be true ; but there are many instances recorded, in 
which examinations after death have not detected any disorder 
v of these organs, which might be assigned as the cause of the 
fatal termination. It is conceded, therefore, that our knowl- 
edge of the subject, does not enable us to decide on the par- 
ticular organs affected by it. But, although we are bound to 
acknowledge our power over this disease to be so limited, ex- 
perience justifies us in hoping, that a proper attention to reme- 
dies and regimen, during the forming stage of the disease, may 



48S EPILEPSY. 

result in its arrest. The patient, therefore, on the first attack 
is not to be abandoned to despair. 

SYMPTOMS. 

The most violent cases of epilepsy are those in which the 
disease comes on suddenly. In a moment the patient falls 
perfectly senseless ; he ceases to breathe perhaps for a minute 
or two, when the most violent convulsions of the voluntary 
muscles take place ; the arms, legs, and neck are thrown into 
the most violent contortions, with a force far be} T ond the power 
of the individual when not under the attack. These convul- 
sions last for a minute or more, when a small interval is al- 
lowed in which the patient breathes deeply and slowly, and 
then the convulsions are renewed. The contortions of the 
face, the sudden opening and closing of the e}-es, the grinding 
of the teeth, the laceration of the tongue, and the issue of the 
blood} T froth from the mouth, need only to be seen once to im- 
press indelibly on the mind, the terrible features of epilepsy. 
In this wa}', the paroxysm sometimes lasts for hours together ; 
more frequenth", however, the case terminates after the first or 
second parox} T sm, and the patient is left as if in a deep sleep. 
If attempts are made to arouse him from this sleep, he shows 
either a total insensibility, or if partially aroused, a great want 
of consciousness. So complete is the insensibility produced in 
the first moments of the attack, that such patients frequently 
fall into the fire, where they lie without moving till they are 
frightfully burned. But should the patient escape such a ca- 
tastrophe, he recovers his senses slowly, and this recovery is 
less and less perfect as the case progresses towards a fatal ter- 
mination, the mind commonly giving way before the powers 
of life. 

In other cases, the attack is also ushered in without any 
symptoms of its approach, till almost at the very instant it takes 
place. The patient is suddenly affected with a slight sensation, 
as if some slight vapor was passing over the finger or other 
part up towards the body. Writers have termed this sensa- 
tion aura epihjjfica, a terra which would signify how very 
slight the sensation itself is. The patient is, however, not de- 
ceived, but knows that it signifies the approach of his terrible 
disorder, and is in a high degree alarmed and terrified. He 
runs suddenly to a bed, or to some place of safety, where the 
convulsion comes on with all the violence we have above de- 
scribed. 

In some instances, the disease is not so sudden in its at- 



EPILEPSY. 489 

tacks ; and the patient is warned of its approach by symptoms 
which precede the attack several hours. These symptoms va- 
ry in different instances ; most commonly they affect the head, 
in other instances, a great oppression is felt about the heart, 
great sluggishness and stupor are felt for au uncertain length 
of time ; when the paroxysm comes on, with as much violence 
as in other cases. There are yet milder cases in which the 
attack seems to last but for a moment ; the patient will fall 
and without having any evident convulsions rise again to pur- 
sue his occupation whatever it may be. These cases have ob- 
tained the name of falling sickness, but do not differ material- 
ly, except in degree from other cases of epilepsy. 

The state of the pulse seems not to have been very much no- 
ticed, in this disease. During the intervals it seems not to be 
much altered ; indeed there seems at that time to be no change 
in it which can be properly referred to epilepsy. But in the lew 
instances in which it has been in my power to examine the 
pulse immediately before the attack, it has been depressed and 
feeble, but sometimes slow. After the violent convulsion has 
taken place, the pulse is full and resisting ; and the heat of the 
body rapidly increases for a time, but seldom results in fever. 

A suspension of the intellectual faculties, of thought, memo- 
ry, judgment, and even sensation, is the invariable characte- 
ristic of epilepsy. The patient never remembers that which 
transpires from the time he is attacked, till he has passed en- 
tirely through the paroxysm. 

Epilepsy, during its first stage, is not apt to be frequent in 
its attacks ; sometimes the patient will pass years before the 
disease is renewed. If the case grows worse, the attacks be- 
come more frequent, and they have, from time immemorial, 
been supposed to be governed more or less by the moon ; the 
attack will come on at the full or at the change. Gradually 
the periods of the attack will become shorter, and more violent, 
sometimes affecting the health of the patient seriously. The 
mind very commonly gives way, when the attacks become 
very frequent, and the patient is reduced to a state of idiocy. 
The attacks most frequently come on at night, often during 
sleep ; and in this way, the disease goes on with increasing 
violence, till the patient is destroyed. The duration of the dis- 
ease is uncertain ; it may last an ordinary life time; but it is 
sometimes destructive of life in a few years. 

TREATMENT OF EPILEPSY. 

There are few cases of epilepsy so hopeless, as to justify 



490 EPILEPSY. 

abandoning the patient to the mere operation of nature. If his 
symptoms cannot be eradicated, they may be, in some degree, 
ameliorated, and his situation rendered less uncomfortable. In 
the worst cases, where an attention to regimen and nursing 
form the principal part of what can be done, these things should 
be directed by the soundest judgment and maturest experi- 
ence. If he can afford it, the patient should have with him at 
all times, a confidential and strong assistant or nurse. He 
should never be allowed to ride on horse back, and far less, to 
drive a carriage. He should not go even with his nurse into 
crowded streets, where an attack of his disease might expose 
him to more danger ; and should be kept at all times in a situa- 
tion, in which the attack might not be attended with any par- 
ticular danger. If he goes abroad, his attendant should be 
provided with an air pillow, which might in a moment be in- 
flated and placed under his head, in the event of his falling on 
a hard or uneven place ; a chord should also be in the pocket 
of the attendant in cases in which the attack is first felt in any 
of the limbs, for in such cases, the paroxysm is often hindered 
by suddenly binding the chord around the limb above the point 
at which the affection is felt. His companion should also have 
in his pocket a wedge of soft wood to interpose between the 
teeth, and a draught of stimulating medicine, ready prepared 
for administration. A portion of ether, spirits of camphor, or 
laudanum, readily portioned out, and diluted with water for 
administration, will answer. This portion should be given to 
such patients as have even a very short notice of the approach 
of the attack, immediately on their giving notice of it to their 
attendant. Such a portion will very often arrest the parox- 
ysm ; and I think I am not mistaken in saying, that I have 
seen this simple measure, by being persisted in, eradicate and 
destroy the disease. When the attack has taken place, the 
patient should, if possible, be laid on a wide bed, or even mat- 
trass ; and too much constraint ought not to be imposed on 
him, but just so much as will hinder him from injuring himself. 
No attempt should be made at this time to administer to him, 
any medicine, or compel him to breathe the usual stimulants 
which are offered in this way to fainting persons. 

The remedies proper to be administered during the par- 
oxysm of epilepsy, cannot be numerous ; for the patient is in- 
capable of swallowing them. Whether the newly introduced 
remedies, such as ether and cloroform, which are administered 
by being inhaled while they are in a state of vapor in the at- 
mosphere, would be useful in such a crisis, has not, as far as I 



EPILEPSY. 491 

am informed, been put to the proof. My impression is, that 
they offer a prospect of great utility, but I shall not venture to 
recommend any of them. The principal remedy which I have 
used in these cases is bloodletting. It should not be practiced 
too soon, but after the pulse has become fall, strong, and re- 
sisting. This will take place probably before the convulsions 
have altogether ceased, and should be practiced as soon as the 
state of the pulse seems to require it. I think I have seen ve- 
ry great benefit derived from this remedy, all the symptoms 
becoming moderate, and disappearing soon after its use. The 
quantity of blood abstracted should not be great, a pint or a 
pint and a half, will generally be sufficient ; and the operation 
should not be repeated oftener than twice a month, and not at 
all in conhrmed and longstanding cases. Cold applications 
to the head, made by means of ice in bladders, or cold water 
on towels, will, I have no doubt, render good service in many 
cases. Where the attack is protracted, and some degree of 
fever appears, even before the convulsions cease, this appli- 
cation seems to be the more demanded. 

The remedies proper to be used during the intervals be- 
tween the paroxysms, are a matter of more doubt and uncer- 
tainty. A great deal has been said, in regard to the local dis- 
orders with which epilepsy seems in some instances to be as- 
sociated. Certain cases seem manifestly to have their origin 
in the brain ; depending as it would appear on malformation 
of the skull. Depressions of the skull from wounds, produce 
cases of this kind ; and examinations after death have shown 
the presence of tumors, and certain alterations in the brain it- 
self, which were calculated to impede the functions of that or- 
gan in a similar way. The only remedy which has been pro- 
posed in cases of this kind, has been certain artificial means of 
compressing the great arteries which lead from the heart to 
the brain. This lessens the force of the blood in its circulation 
through the brain, and has been thought of great service in 
some cases. This remedy is easily tested by placing the 
thumbs over the pulsation of the arteries in the neck, during 
the paroxysm, or so soon as it has subsided sufficiently to ad- 
mit of it. The pressure should be regulated according to the 
judgment of the practitioner, and if found useful, some means 
to protract the pressure may be easily invented. 

Disorders of the stomach are frequently thought to have a 
very close connexion with certain cases of epilepsy. In such 
cases, the attack is found to follow excess in eating, or indeed 
in drinking. I have no doubt that many cases of epilepsy are 



492 EPILEPSY. 

aggravated by the disposition of the patient to indulge in eat- 
ing. This unfortunate propensity, which seems to be born 
with so many persons, and tends to the production of dyspep- 
sia, by excesses of eating, is of itself no cause for epilepsy. 
Still it may be a peculiar misfortune of epileptic persons, and 
requires great care and discretion in its management. Dys- 
peptics who are epileptics, should be treated with still more 
care than other dyspeptics ; but they are to be treated for dys- 
pepsia, and on the same rules wdiich will be given fot the treat- 
ment of that disease, in other cases. In these cases, the pa- 
tient is frequently found to be feverish and excited, many days 
after a severe paroxysm of the disease. It is under these cir- 
cumstances, that the use of emetics has been found beneficial. 
A common dose of ipecac, thirty grains, administered at once, 
will answer very well. If the fever still continues, and a more 
powerful remedy is thought necessary, take six grains of tar- 
tar emetic, put it into three table spoonsful of water, and give 
one every thirty minutes, till it proves emetic. It will be whol- 
ly useless to persist in giving such patients active depleting 
remedies. They have been tried to an extent that would 
hardly be credited, and they have been found useless or worse. 
The patient is to be treated as I have observed, for dyspepsia. 
These remedies look to the re-establishment in the patient, of 
a degree of health, which shall favor his escape from repeated 
attacks of his disease. They are, it will be acknowledged, 
too often jfeoductive of no greater benefit. 

A class of remedies denominated alterative, would seem to 
be exactly suited to cases of epilepsy. They have been tried 
without much success. In certain cases, where the disease 
has seemed to depend on an affection of the liver, calomel has 
been found of great service. So far, it has not occurred to me 
in such cases to use this remedy with any advantage. I have 
several times prescribed it, but am bound to say, without any 
evident benefit. A new remedy of this kind has been intro- 
duced ; the hydriodate of potash. This remedy I am told is 
now administered with some degree of confidence ; and I have 
lately prescribed it ; but so far cannot vouch for its good effect. 
Four or five grains of this remedy dissolved in water, may be 
given, once or twice a da}', for an indefinite time. 

The remedies which I have used to most profit in epilepsy, 
are diffusible stimulants, and tonics. The diffusible stimu- 
lants, are useful in cases in which the patient has some warn- 
ing of the approach of the paroxysm. Where such remedies 
can be taken, half an hour or longer before the attack comes on, 



EPILEPSY. 493 

there is great hope of arresting it. Where the patient is sen- 
sible that his attack approaches, he may take ten grains of 
camphor, dissolved in a little spirit, or a tea spoonful of com- 
pound spirits of lavender, or thirty drops of water of ammonia, 
or, in the absence of these, a strong glass of brandy and water. 
Any of these means, or other similar remedies, may be used. 
I have used tincture of assafcetida, and tincture of castor, with 
the happiest effects in these cases. Many years ago, I had 
placed under my charge, a mulatto boy, who had paroxysms 
of epilepsy twice a month, and three or four days in succession, 
at each term. The attack came on with the aura epileptica, 
or that strange sensation of a stream of air from the little ringer 
up the arm. Several minutes would intervene between the 
occurrence of this symptom, and the loss of consciousness 
which attended the convulsion. The boy was directed to 
remain near my office, in which his stimulating draught was 
always kept in readiness. He Was directed to run instantly, 
and take it whenever he felt his disease in his hand. The 
remedy he used was purposely varied, laudanum, camphor, 
spirits of lavender, or tincture of assafcetida or castor, were in- 
differently used. For many weeks he continued subject to his 
attacks, and would be seen to drop his employment and to fly 
with the greatest trepidation to his remedy. It was soon found 
that it had the control of the paroxysm ; and by persisting in the 
use of these remedies for about three months, he ceased to 
have any return of the disease, and remained free from it as 
long as he lived. Little need be added on this head ; the par- 
ticular symptoms which point to the approach of the paroxysm, 
in different cases, are so various, that it would be in vain to 
attempt to particularize them. The mode of treatment is to 
first find out the exact time at which the paroxysm may be ex- 
pected, and to anticipate, and if possible, to hinder it by the 
means I have mentioned. 

Where the attack of the disease is sudden, and without pre- 
monitory signs, our reliance is on tonic medicines. The pre- 
perations of iron stand first with me on this list ; about three 
grains of sulphate of iron or common copperas, may be given 
three times a day. It may be made into pills with turpentine, 
by first being reduced to powder by heat in an iron vessel, and 
then mixed with the turpentine and formed into pills. The 
carbonate of iron may be given instead of this, and should be 
given in doses of five or six grans, twice or three times a day. 
Warm stomachic remedies may be given in combination with 
these. Powdered ginger, or cayenne pepper, may be combin- 



494 EPILEPSY. 

ed with them in making them into pills. In place of these 
remedies, other tonics may be used, and I know none entitled 
to much preference over the compound tincture of gentian, 
which maybe given in doses of one or two tea spoonsful, before 
breakfast and before dinner. Or the extract of gentian, made 
into pills of four grains each, may be substituted, two pills 
being the dose. Tincture of valerian, has been thought par- 
ticularly beneficial in some of these cases. It may be given in 
doses of from one to two tea spoonsful, two or three times a 
day. Tincture of assafcetida and tincture of castor are in my 
opinion better remedies ; but in reference to all these remedies, 
both stimulating and tonic, it should be observed that they 
are not to be continued for too great a length of time, without 
being changed for others ; it being a general fact, that medi- 
cines persisted in for too great a length of time, cease, in a 
great degree, to have their usual effect. Cathartic medicines 
have been much used in epilepsy. Experience does not seem 
to warrant the use of them, any farther than the state of the 
bowels in reference to the performance of their proper func- 
tions requires. A state of constipation should not be allowed 
to continue for any considerable length of time. The usual 
means of remedying this state of the bowels are proper here. 
A powder of equal parts of sulphur and cream of tartar, may 
be taken by the tea spoonful, once or twice a day according to 
circumstances. Pills of aloes may also be used. These, or 
any other very mild cathartic medicine may be used, when the 
symptoms seem to require it. 

We are now to consider another class of remedies — those 
which act on the mind. Few things look more stolid and in- 
different, than patients who are affected with epilepsy. It 
would be thought, that of all others, it would be hardest to 
reach their diseases through remedies operating merely on the 
mind. But we are bound to acknowledge, that where reme- 
dies having no other merit than this, have been brought to bear 
with great force on individuals suffering under this great af- 
fliction, many of the most unquestionable cures have been ef- 
fected. The remedies which have been used for this purpose, 
have, in some instances, been such as to shock every sense of 
propriety or morals. Such patients have been induced to 
drink the blood of a malefactor ; to take in powder the bones 
of the skull, or other definite part of some great criminal. It 
would be useless to pursue the enquiry, or to enumerate the 
many articles which have been used in this way with success. 
Influences solely moral or religious, have also wrought their 



LOCKED JAW. 495 

miracles, out in this disease. Men standing high in the church, 
have set themselves up for the performance of these miracles; 
and many are the cases in which the miracle has seemed to be 
performed. Anything particularly shocking to the senses may 
accomplish the same purpose. There is at this time, a negro 
man, wearing around his necl^ a bit of rope, with which he be- 
lieves a negro has been hanged. Some years ago, he was at- 
tacked with epilepsy, and being told that the wearing around 
his neck a rope which had been used to hang another, would 
cure his disease, and it happening opportunely, that one of his 
own color had been executed in the same neighborhood, the 
rope was procured and tied about his neck. His epilepsy in- 
stantly ceased ; but after many months his owner removed the 
rope, and in a very short time his disease returned. Another 
rope was now procured, and he was made to believe that this 
rope had performed the same office of hanging another. This 
second cord was now bound around his neck, and the disease 
has disappeared. He now wears the cord, and is free from 
his dangerous disorder. Time is yet to show whether the 
remedy is permanent. 

These remedies seem to have their foundation, in inspiring 
the patient with fear and horror ; or, on the other hand, im- 
parting to his mind, an unshaken confidence in their effect. 
Our great difficulty is, in producing a sufficient effect on the 
mind, without producing an effect too great to be safely borne. 
The disease itself is often brought on by sudden and great 
emotion. The awe and alarm produced by seeing a person 
have it, have often produced it in others. How then are we 
to manage a remedy whose operation we cannot foresee, and 
which may prove more destructive than the disease ? More 
than all, it is obliged to be true, that such remedies can be use- 
ful only to the most ignorant. They are but little attempted 
by those who lead in the practice of medicine ; and I confess, 
that I have nothing to suggest in reference to them. Where a 
case of the disease occurs under circumstances suited to the 
operation of this powerful moral cause, it must be left to the 
good sense and discretion of those concerned, to avail them- 
selves of their agency. 



LOCKED JAW— TETANUS. 

The common name of this disease is so descriptive of its 
character, that it cannot be improved. When fully establish- 
ed, the jaws are so firmly closed, as to be incapable of being 



496 LOCKED JAW. 

opened by any feasible degree of force, or by the voluntary ef- 
forts of the sufferer. 

The attack of this disease is sometimes sudden. It is said 
that the jaws are sometimes closed with a sudden snap. This 
it has not occurred to me to witness, but I have seen the jaws 
firmly closed within six hours of the onset of the disease. 
The first symptom which is observed by the patient, is a stiff- 
ness in the back of the neck, extending upwards towards the 
head. Some degree of soreness, and, especially, of dryness of 
the throat, is present at the same time. Very soon, a pain is 
felt under the sternum, which becomes, in the progress of the 
disease, violent — as some have termed it, stabbing. This pain 
is, I have no doubt, seated in the diaphragm. By degrees, 
the muscles of the neck become contracted and firm in front; 
and the patient moves his head with some difficulty. The 
muscles of the abdomen become firm, and somewhat contract- 
ed ; and those of the back also soon take up the permanent 
spasm which constitutes the leading feature of this disease. 
At length the head is observed to be drawn back, and the whole 
spine curved more or less backwards : and this curve of the 
spine has been thought sufficient to characterize a variety of 
the disease; for the whole body, from head to foot, is drawn 
and stiffened backwards, in almost a semicircular form. In 
other instances, the muscules in front of the body seem to get 
the advantage ; and the whole person is thrown as it were into 
the form of a hoop, in that direction. The firmness and per- 
manency of these spasms, is such as to forbid the attempt to 
bend the limbs in any direction. When the person is drawn 
nearly straight by placing the hands under the head, and rais- 
ing the body, it will appear as firm and solid, as a piece of 
wood. The breathing becomes, by degrees, very much op- 
pressed ; and the throat so contracted and ungovernable, that 
the patient becomes unable to swallow. Fluids, especially, 
become intolerable to him ; and I have seen the fear of attempt- 
ing to swallow water, as great as it could possibly have been 
in hydrophobia. The countenance, owing to the contractions 
of the muscles of the face, becomes distorted in a very great 
degree ; sometimes to an extent truly frightful. The eyes 
seem to be drawn as it were nearer to the temples; tears flow 
down the face, and saliva issues from the mouth, exhibiting a 
spectacle of human suffering which can hardly be equalled in 
any other disease. 

These violent spasms of the muscles take place without any 
affection of the mind. Some have stated that there is no de- 



LOCKED JAW. 497 

pression of spirits, and that the mind is wonderfully buoyant, 
and supported in these circumstances. My own observation 
does not confirm this statement. I remember a single instance, 
in which the patient seemed disposed to make a jest of his suf- 
ferings ; but in every other instance in which I have witnessed 
it, the mind was filled with the deepest despair. Nor did the 
expression of the countenance produce a different impression 
on the mind of the beholder. Even before the contractions of 
the muscles of the jaws had rendered swallowing difficult, I 
have seen the countenance present the picture of despair. Still 
it is true, that the powers of the mind remain unclouded: there 
seems to be no lack of judgment, or of perception. The sensi- 
bility seems to be affected in a peculiar manner; a slight touch 
or tickling of the body, will produce a sudden and violent con- 
vulsion. I have noticed this particularly, on attempting to pass 
my hand near the pit of the stomach. 

The peculiar affection of the nervous system in this disease, 
is worthy of notice ; the contractions of the muscles do not ap- 
pear to be firm and unresisting, from the first ; but many sud- 
den, and, as it were, electric contractions, take place, which 
leave the patient less and less capable of controlling the mo- 
tions of the parts. Afterwards, by degrees, the contraction 
becomes permanent ; but even to the last, an attempt to han- 
dle or move the patient, or even an attempt by himself to do 
any thing, will throw him into a sudden and violent spasms. 

The pulse seems to be but little affected at the commence- 
ment of the disease ; but it becomes gradually feverish and ex- 
cited, and has been described by some, as running by degrees 
into an inflammatory state. I can not say, that this has been 
according to my observation. I have thought the pulse won- 
derfully tranquil, and but little affected, even in violent cases. 

Tetanus, has, of late, been divided into the chronic, and 
acute forms ; and this division I consider very judicious. But 
it is not always in our power, to assign positively to its place 
each case we may meet with. Chronic and acute can signify 
only a rapid and violent, or a slow, and protracted form. The 
length of time which shall constitute the one or the other, can- 
not be perfectly decided. I should say, that an acute case will 
produce the full developement of its worst symptoms, in two 
days ; while a chronic case, will be twice that length of time, 
or longer, in getting to its worst. If death takes place in an 
acute case, it will probably occur in four or five days ; while a 
chronic case will last four or five times as long. 
32 



498 LOCKED JAW. 

CAUSES. 

A further division of tetanus has been founded on the differ- 
ence in its remote causes. In most instances, 'the disease ari- 
ses from some wound or injury inflicted on the bod}' ; but the 
probability of the disease succeeding any particular wound, 
cannot be foreseen. No wound is too slight to produce it ; and 
none so bad, as to make its attack an object of particular fear. 

In this climate, tetanus is a rare disease. I have witnessed 
about one case per annum ; and of the cases I have seen, nine- 
tenths have followed the infliction of some wound. I have seen it 
arise from a burn on the arm, not an inch in diameter, which 
had entirely healed at the commencement of the disease ; and 
I have seen it arise in three days from a gun shot wound 
in the foot. The same accident accuring to two persons 
under the same circumstances, as far as we can judge of 
them, will in one produce this disease, and in another not. It has 
occurred to me to attend to two young men who had suffered 
the same injury, each having leaped from a considerable height 
on the point of a twenty penny nail, which pierced the centre 
of the foot, entirely through. In one instance, a violent inflam- 
mation and suppuration took place, with the loss of several 
bones from the loot ; in the other, a violent locked jaw took 
place on the fourth day ; but very little inflammation ensued in 
the foot, and both of these cases finally recovered. So far as 
I have observed, the disease occurs principally in youth, be- 
tween the ages of ten and thirty years. 

I must not omit to mention in this place, the tetanus nascen- 
tium, or locked jaw of infants, which we occasionally meet 
with. This disease attacks infants from four days, to two or 
three weeks old. It is almost always fatal. I have seen but 
a single case of recovery ; and even in that, the symptoms 
were not fully developed. It is so rare in this country, that it 
is not a matter of particular fear; though I have witnessed a 
dozen or more cases of it. I attribute it to the healing of the 
navel, which operates in this case as the closing of a wound. I 
know of no mode of guarding against it, nor have I any reme- 
dies to offer, but those applicable to other cases. 

Although this disease, when fully developed, and having 
continued for some length of time, is so widely different from 
all others, that it would seem impossible to mistake it ; there 
is yet a necessity of being on our guard against mistaking it 
for several other diseases, in its commencement. We have al- 
ready stated its great resemblance to hydrophobia ; and I am 



LOCKED JAW. 499 

persuaded, that cases of the two diseases sometimes produce 
symptoms so perfectly identical, that the discrimination would 
be exceedingly difficult. In hydrophobia ; there is commonly 
an easy refference to the bite of a rabid animal, as the cause ; 
but I have seen tetanus succeed the bite of a dog not rabid, 
which yet produced symptoms so like hydrophobia, that they 
would have been easily mistaken for that disease. The differ- 
ence between these cases consists principally in the perma- 
nency in the spasms of tetanus, while those of rrydrophobia are 
only occasional. The mind also in hydrophobia becomes dis- 
ordered. Hysteria is another of the spasmodic diseases which 
sometimes resemble tetanus. 1 have seen this resemblance so 
close, as to have been myself in great and very embarrassing 
doubt of the nature of the disease. A little time and observa- 
tion will always enable us to correct a mistake of this kind. 
It is only necessary to mention it, and no ill will result from 
this resemblance. The jaws are sometimes closed by certain 
swellings of the face, which might lead the inattentive obser- 
ver into a serious mistake on this subject. In these cases, the 
tenderness of the parts will point out the nature of the disease. 
There are certain poisons that produce symptoms, which it 
would not be easy to discriminate from tetanus. One of them, 
nux vomica, it is said, produces symptoms so exactly resemb- 
ling tetanus, as to be discriminated with the greatest difficul- 
ty. It is a rare case for this article to be taken to this extent. 
"Strychnine, a salt which has been obtained from nux vomica, 
when taken in excess, or criminally given as a poison, is the 
most probable source of this accident. The investigation of 
any fact which might lead to the supposition, that tetanus had 
arisen from this cause, should be made with due care. These 
suggestions are dropped here, not that they will be very apt to 
be often required to be used ; but that it is our duty to be pre- 
pared, if such cases present themselves. 

The causes of tetanus which it is in our power to guard 
against, or modify, are very few. It is agreed, that the dis- 
ease prevails much more in tropical climates, than in milder or 
colder latitudes. Dampness is thought to be a great auxiliary 
cause. The tetanus. of infants is so common in the West In- 
dies, that it is regarded with the greatest fear. In low and 
damp localities, it is said that the children of slaves born there, 
perish by it in great numbers. In this country, from thirty to 
thirty-four degrees north latitude, the disease is not common, 
though occasionally met with. From wounds, it is also rare, 
and no precaution in regard to their treatment, has been proved 



500 LOCKED JAW. 

to be of any avail. The disease is as apt to come on after a 
slight, as after a greater injury; and the most dangerous pe- 
riod in the treatment of wounds is about the time they heal. 
The cases of tetanus which take place without the previous 
existence of any wound or injury, are most frequently attribu- 
ted to exposure to dampness and cold. A man in a state of in- 
toxicatiou fell down and slept, exposed to the dampness of 
night and a light rain which happened to fall. I was called 
to him the next morning, when I found him laboring under the 
symptoms of tetanus. Many other cases of like kind have been 
recorded ; but it is not the intoxicated alone who have reason 
to fear the ill consequences of sleeping exposed to the night 
air. This cause will produce it in many persons, who are of 
the most temperate habits. The time at which the disease 
makes its appearance, after the patient has been exposed to 
the remote cause, is uncertain. When it arises from exposure, 
the disease makes its appearance in a shorter time ; but, from 
whatever cause it may arise, it will make its appearance with- 
in two or three weeks. 

TREATMENT. 

If the symptoms of this disease are formidable, the remedies 
which have been recommended in the treatment of it, are not 
less so. The doses of narcotics, and stimulants, which have 
been administered have been beyond all reasonable measure ; 
and it must be confessed, that patients in tetanus bear the use 
of these stimulants with wonderful endurance. On the other 
hand, led by a different theory, there are authors of great re- 
pute, who insist on bleeding, and other depleting remedies. 
In the midst of this confusion, and without presuming to offer 
remedies with more confidence than they are entitled to, I shall 
state in a few words the remedies which I use in tetanus. 

After having made up my mind conclusively, that it is a 
case of locked-jaw which I have to treat, I lose no time in ad- 
ministering opium, which I regard as the most powerful reme- 
dy in this disease. A large tea spoonful of laudanum, or four 
or five grains of opium, may be administered at once. If the 
spasms give way, which they sometimes will do, in less than 
an hour, the remedy is not to be lost sight of; but, after four or 
five hours, repeated in a smaller dose, perhaps half the quanti- 
ty at first administered. This remedy is to be repeated ac- 
cording to circumstances, during the whole course of the treat- 
ment, taking care to lessen the dose, when its narcotic effects 



LOCKED JAW. 501 

appear too powerful. If the patient sleeps soundly, he is not 
to be aroused 1o take bis remedy ; but to pass on till the effect 
of the former dose has sufficiently subsided. Where the case 
becomes protracted, the use of opium is still to be continued, 
under such modifications, and combined with such other stimu- 
lants, as the case may seem to require. 

As soon as the first dose of opium is administered, prepare 
a plaster of mustard, about four inches in width, and a foot in 
length. Apply this along the course of the spine, from the 
nape of the neck downwards. Let this plaster remain for an 
hour or longer. Examine the skin, and see that the plaster is 
continued, nearly to the point of blistering. Then remove the 
plaster, and apply oil over the part ; but do not use cabage 
leaves or a poultice, it being the object to continue the excite- 
ment in the skin, as long as it will remain. 

If, by the use of these remedies, the patient is not immedi- 
ately relieved of the spasm of the jaws, and pain about the pit 
of the stomach, he is to take in addition, proof spirits of any 
kind — cogniac brandy may be used in preference. He will 
take of this, diluted with water, about half a gill at a time, and 
repeat it if necessary every two hours, till a quart is taken. 
This remedy, when thus used in combination with opium, is 
sometimes tbund to arrest the spasms, when the opium itself 
has failed. I have seen it produce a fit of intoxication, and 
with it, the instant cessation of the disease , and to all appear- 
ance, lay the foundation of a cure. This remedy is also to be 
continued to the end, under such modifications as the case may 
seem to demand. 

In combination with the opium, I have administered from 
two to four grains of camphor, with each grain of opium. This, 
I have no doubt, is a valuable additional remedy, and is to be 
continued under the same limitations, advised lor other reme- 
dies. 

I have tried many remedies besides these, especially sul- 
phate of quinine, and various other stimulants and tonics; but 
I do not believe they are entitled to any preference over those 
I have already recommended. 

These remedies are suited to the highest grade of tetanus ; 
and I should hardly think it necessa^, under any circumstan- 
ces, to give doses larger than those I have recommended. 
Where the case so far yields to the remedies, as to show a ces- 
sation of the spasms, after their use, the physician has, from 
that time, to lessen his doses, and barely urge them to a suffi- 
cient extent, to keep the symptoms relieved. He will, in this 



502 LOCKED JAW, 

wa} r , for many days together, find it necessary to be watchful 
of his patient ; and he will be satisfied, that the disease is at all 
times ready to return, as soon«as the remedy is suspended, 
Where the advantage is once gained, and the spasms are sub- 
dued, the case will, with due attention, almost certainly termi- 
mate favorably. 

The danger of tetanus is in proportion to the violence of the 
attack ; and when the remedies which have been suggested, do 
not arrest the spasms, when the pulse becomes rapid, and the 
patient bathed from head to foot in perspiration , a rapid and 
fatal termination may be expected. When on the contrary, 
the spasms give way, and the patient finds himself free from 
pain b}r the use of a few doses of his remedies, the case will al- 
most certainly give way to proper treatment. It has been said, 
that the chronic cases were not fatal under any mode of treat- 
ment ; and that the acute cases were never relieved by reme- 
dies. This is not strictly in conformity with my experience. 
I think I have treated cases of the most acute kind, with suc- 
cess. 

Doctor Rush, who seldom treated of any disease without 
advising bloodletting, advises this remedy in tetanus. When 
I first met with the disease, I tried it, and in addition to it, 
other remedies equally depleting. This course w r as taken in con- 
sultation with other physicians, and was then deemed the most 
promising of success. All the cases which I saw treated in 
this way, either under my own, or the direction of other per- 
sons, terminated fatally. Several years had passed, and I be- 
lieved that tetanus was incurable. At length, a mulatto girl 
of twelve years old, from having received a small burn on her 
arm, was taken with this disease. I applied a sinapism along 
the spine, gave a large dose of opium, and left with her mother 
a pint of rum to be given in the course of the night. The next 
morning, I found my patient free from spasm or pain. She 
had not complained of the mustard, and it had been suffered 
to remain until the skin under it was entirely destroyed. A 
very foul and long continued ulcer, was the consequence. 
For several days the stimulants were continued ;. and I thought 
myself warranted in withdrawing the opium and rum. But, 
on visiting my patient in the morning, I found her spine so 
curved backwards, as not to admit of her standing on her feet. 
She was relieved again bv the renewal of the laudanum and 
rum, and got well under the use of about a quart of rum, with 
from sixty to a hundred and twenty drops of laudanum each 
day. This case occurred before it had been suggested* that 



503 

there was a chronic form of tetanus. I believe from what I 
remember of it, that it was entitled to be placed in that class ; 
and from that time till now, I have treated with success all 
the cases of this class, which I have met with. 

But I have said, that it was not the chronic cases alone, 
which seemed to yield to these remedies. A strong negro man 
after receiving a terrible punctured wound in his foot, was seiz- 
ed with locked-jaw in three days. His symptoms were very 
violent. I gave him about five grains of opium, and applied a 
sinapism to his spine, leaving his mistress with directions to 
administer brandy and water, as fast as he could be got to take 
it, till he was relieved, or a quart of brandy taken. This was 
dil.gently done, and it required perseverance ; for he swallow- 
ed villi great difficulty. In an hour or two, he had taken more 
than a pint of brandy, and became suddenly and furiously in- 
toxicated. He arose from his bed, drove every one from his 
presence, and acted like a maniac for an hour or more. When 
I arrived, his violence had subsided, and his disease was gone. 
He was diligently, and uniformly stimulated with laudanum 
and brandy, for a number of days. The disease showed an 
evident tendency to return again, and again, but always gave 
way to the same remedies. Finally it subsided, and returned 
no more. 

I could mention many other cases of this disease, which have 
been treated with like success ; but it would be useless. It is 
enough to say, that since I adopted the plan of treatment which 
I have described above, I have succeeded in relieving more 
than half of the cases of tetanus which have fallen under my 
care. 



SAINT VITUS'S DANCE— CHOREA. 

This is a disease of the voluntary powers. The patient 
seems to lose the power of self-control, and is forced, in spite 
of himself, to t'ue performance of various, and sometimes, 
strange and grotesque motions. These motions differ from the 
convulsions of epilepsy in this ; that, in chorea, the patient re- 
tains his consciousness, and is capable of making some volun- 
tary efforts, though insufficient to control those, which are 
brought on by the disease. It differs from locked-jaw, in the 
perpetual motion to and fro, which it produces ; and it may be 
discriminated from hysteria, from the absence of that state of 
the mind which attends that disorder. 



504 

Saint Vitus's dance is a disease of youth, or rather child- 
hood ; the attack almost always happening before the age of 
puberty. It is most frequent in girls, from the age of eight to 
twelve years ; but, in a few instances, occurs in. the other sex. 
It may occur at almost any period of life. It is a disease rath- 
er disagreeble than dangerous ; although, in some instances, it 
continues for the remainder of life, and has, in a few cases, 
proved fatal. Its mean duration may be set down, at from a 
month to six weeks ; but it frequently continues for six months, 
or even longer. It is most likely to occur in persons, who are 
of what has been termed a nervous temperament. It has been 
particularly noticed, in those who are subject to sudden aid 
strong emotions, from fear or other passions. 

SYMPTOMS. 

The attack of chorea, is not preceded by any known pre- 
monitory signs. The patient will be seen to perform some 
motion involuntarily ; it may be a shuffle of the foot. More 
frequently it attacks the muscles of the face, producing violent 
contortions and grimaces ; these motions are sometines ex- 
ceedingly rapid; the eyes will sometimes open and shut too 
rapidly for enumeration ; the hands will move sometimes with 
equal rapidity ; and, in other instances, the head will turn 
from side to side, more rapidly than could be done by any 
voluntary effort. These motions may, at first, las: but a few 
minutes ; but they return again, and continue for a longer 
time, till, at last, they seem to be established in some particular 
muscies, and continue for many years together. But this ra- 
pidity of motion is not common in protracted cases. I think 
the motions are generally slow, compared with the spasm of 
hysteria, or epilepsy. Sleep almost always suspends these 
motions ; but the patient wakes again, to experience the same 
disagreeable visitation. 

The mind does not participate in these disorders, but is, to 
a wonderful extent, calm and undisturbed. Instances have 
been mentioned, in which, from a combination of hysterical 
symptoms, the mind in chorea became much disorderd ; but 
such a case has not presented itself to me. The general health 
of the body seems also to be but little disturbed. There is lit- 
tle or no fever, and if any disorder is noticed, it will probably 
be some derangement of the intestinal canal — it may be a di- 
arrhoea, or it may be costiveness. 



SAINT VITUS'S DANCE. 505 

TREATMENT. 

Many remedies have been urged with great confidence on 
the profession, as cures for Saint Vitus's dance. It would be 
tedious even to enumerate them. Re^ardin^ the disease as 
one founded on debility, and arising from the imperfect per- 
formance of the natural functions of the body, I have fallen into 
the class of those who treat it with restorative, and supporting 
remedies. And this course of treatment, I believe, has the 
sanction of a very large majority of the medical profession. 

The preparations of iron have been recommended by almost 
all, who have treated of this disease ; and I have found them 
worthy of their high character, in its treatment.. Take of car- 
bonate of iron half an ounce, syrup or honey two ounces, or 
four large table spoonsful; mix well together, and give two 
tea spoonsful twice a da}'. Such a dose will contain from ten 
to fifteen grains of the medicine. But practitioners have in- 
dulged in an almost unlimited use ol this remedv- in this dis- 
ease, twice, three times, or even four times what I recommend, 
have been often given ; but I believe there is no use in giving 
larger doses, than those I have recommended. Several other 
preparations of iron are entitled to equal confidence with the 
one I have named. The precipitated carbonate, or red carbo- 
nate, is entitled to equal confidence in my estimation. The 
sulphate of iron, reduced to a dry powder, and administered 
in doses of two or three grains, has been w T ell spoken of. If 
the patient can swallow pills, this preparation of iron, made 
into pills, with extract of gentian, would form an excellent pre- 
scription. The muriated tincture of iron, in doses of from ten 
to thirty drops, has also been given, with as much advantage, 
as perhaps any other preparation of this remedy. All these 
preparations of iron, have their advocates, and may be given in 
rotation ; I prefer them in the order in which they are set down. 
That is, I first administer the catbonates, and if they do not 
answer according to roy expectation, I may then change them 
for some other. 

In obstinate cases, the preparations of arsenic have been 
used with success. From the sixteenth to the eighth of a grain 
of arsenic, may be administered, two or three times a day. 
The arseniate of potash, or Fowler's solution, may be admin- 
istered for the same purpose, in doses of from five to ten or 
twelve drops. This remedy, it is conceded, has great control 
over Saint Vitus's dance ; but it should not be persisted in too 
long; I should say not more than four or five days, in succes- 



506 HYSTERICS. 

sion. The danger which may arise from the protracted use of 
arsenic, depends on the liability of that remedy to produce 
paralysis. 

If the patient be a female, approaching the age of pubert} r , 
small doses of calomel, a grain a day, for five or six days, fol- 
lowed by a dose of oil of turpentine, has been highly recom- 
mended. A tea spoonful of the common spirit of turpentine, 
given in a table spoonful of water, is the dose that I should re- 
commend. If it produces no cathartic action on the bowels, 
it should be followed by a dose of castor oil. 

Cold bathing has been highly spoken of, as a remedy in this 
disease. If it is used, it should be in the form of a shower bath, 
continued for only a minute or two, and followed by extensive 
dry friction. Mj own experience with this remedy has not 
been very favorable to its high character. 

I have not enumerated cathartics amongst the remedies for 
chorea. They are to be used for the purpose of regulating the 
bowels, but cannot be relied on as a remedy to arrest the dis- 
ease. If the patient can be got to take pills of aloes and rhu- 
barb, they will probably be the most beneficial cathartic in this 
disease. 

In treating this disease, it is to be regretted that no sudden 
relief of the symptoms can be relied on. They commonly give 
way slowly, and imperceptibly ; and we should be on our 
guard against crowding too many remedies on our patients, at 
onetime. 



HYSTERICS— HYSTERIA. 

This is a disease of but little danger ; but from the similari- 
ty which it sometimes assumes, to other disorders, it becomes 
important that it should be properly understood and discrim- 
inated. It is, moreover, very common, exceedingly annoying 
to persons subject to it, and produces a state of the mind which 
is of itself a very great evil. It is a disease almost exclusivelv 
confined to the female sex. 

The attack of hysteria is most frequent about the age of pu- 
berty ; but it sometimes occurs much sooner. I have seen it 
plainly marked in a child of six years old. From this age on- 
ward, females are subject to attacks of this complaint. Though 
it is much less common in aged women, than in those who are 
in the prime of life. 

Hysteria is a disease which occurs most frequently in parox 



HYSTERICS. 507 

ysms. These paroxysms sometimes affect the mind princi- 
pally ; the patient becomes very much excited. Certain inter- 
nal movements are felt, as if a substance was rolling within 
the body, passing from the lower part of the abdomen up to- 
wards the throat, and producing there a sense of strangulation, 
or suffocation. The patient attempts to remove it by swallow- 
ing, but all in vain ; the choking still becomes worse and 
worse. At length, sudden emotion breaks forth, it may be a fit 
of laughing, which will hold on for many minutes, high and 
boisterous but involuntary. Suddenly it will cease, and a fit 
equally violent of crying, with a profuse flow of tears will take 
place. A great variety of ?3 r mptoms might be mentioned, as 
attending these paroxysms of hysteria ; palpitation at the heart, 
eructations of air from the stomach, in great quantity, cold ex- 
tremities, with a copious discharge of limpid urine. A state 
of great alarm is usually felt by the patient, at the same time. 
These symptoms, in a greater or less degree, may continue for 
an indefinite time. 

In severe cases of this disease, the symptoms become more 
alarming. From an inability to swallow, the patient presently 
becomes unable to breathe ; and for a time, after struggling to 
obtain breath, a loss of consciousness takes place, with violent 
convulsions. These convulsions continue for a few minutes, 
when the patient obtains partial relief and breathes for a short 
time, and they are renewed again, with as much violence as 
ever. They do not appear to affect the muscles of the face and 
jaws, as much as epilepsy, but seem to affect other muscles, 
those of the neck, back, and limbs in preference. 

I have stated, that hysteria frequently resembles other dis- 
orders. This feature has obtained for it a great deal of at- 
tention, to which it would not otherwise have been entitled ; in- 
deed it constitutes at once, the most difficult and important 
matter connected with the disease. The most experienced and 
able practitioners have been frequently deceived ; and have 
mistaken hysterical for other disorders. It becomes us, there- 
fore, to be on our guard, lest we fall into similar errors. 

The disease which bears most resemblance to the more vio- 
lent cases of hysteria, is epilepsy ; and the reader will recol- 
lect, that while hysteria is regarded as a disease more incon- 
venient than alarming, epilepsy is one of the most awful of hu- 
man afflictions. The marks of discrimination between the 
two, are, therefore, of some importance. In the first place, it 
may be remarked, that epilepsy is the most overpowering of 
the nervous diseases. It first destroys consciousnes ; even in 



508 HYSTERICS. 

the slightest cases, the patient forgets himself, and every thing 
else. In hysteria, the mind is not, in the first instance, attack- 
ed ; the spasm precedes the loss of consciousness ; and many 
a time convulsions of considerable violence are experienced, 
while the patients retain a consciousness of every thing which 
passes ; and frequently utter words which show, that the un- 
derstanding is not destroyed. Where the disease is of a light- 
er grade, and does not produce convulsions, no derangement 
of the mind takes place. There is also an obvious difference 
in the violence of the paroxysms of an epileptic fit, and other 
spasmodic diseases. During paroxysms of this disease, breath- 
ing appears to be suspended ; the violent contractions of the 
muscles force out through the mouth and nostrils, a bloody 
froth which, 1 believe, is never seen in hysteria. In the eye, 
there is also a marked difference ; the pupil in epilepsy being 
enlarged, and the eye exceedingly dull ; while in hysteria, 
there is commonly a contracted pupil, and an eye of ordinary 
brightness. 

I have never seen the spasm of hysteria resemble Saint Vitus's 
dance ; but it once occurred to me to see this disease take on the 
symptoms of locked-jaw, with a perfection which could hardly 
be credited. For a time, I confess, that I was entirely deceived 
by these symptoms ; the jaws were so firmly clenched, as to 
render the administration of medicine impracticable, and I 
contented myself w T ith extensive applications of sinapisms. In 
less than half an hour, the symptoms of locked jaw were abat- 
ed, and the nature of the disease was no longer a matter of 
question. 

It would be useless to pursue the subject of the many dis- 
eases, which hysteria seems to have taken it on itself, from 
time to time, to resemble. Diseases of the liver and spleen are 
the most common of these. Pain in the region of these organs 
often becomes very intense, from this disease. This pain, un- 
like ordinary inflammation of these organs, is rather rendered 
worse, than better, by the usual remedies for inflammation; and 
this is sometimes the first reason the physician has to suspect 
their true character. The lungs also are frequently disorder- 
ed, with a peculiar harsh and obstinate cough, which is only to 
be releived by the remedies for hysteria. Diseases of the joints 
and of the spine, are sometimes counterfeited by hysteria ; and 
patients have remained for a long time under the supposition 
that they could not walk, or had incurable defects of the spine, 
or other equally unfounded ideas. Now, the whole of these, 
and many others that have been mentioned by authors, are 



HYSTERICS. 509 

qualified to puzzle and perplex the ablest investigator. It would 
be useless to suggest the means of coming to a knowledge of 
the true cause of these complaints ; for their varieties are in- 
finite, ancl he who might describe all that have happened, would 
be far from having described all that may yet occur. I will 
mention a single feature of these cases ; and I believe it will 
be found common to the whole. Hysteria produces no emacia- 
tion of those who suffer by it. They may have loss of appetite, 
and apparently wasting disease; but yet their limbs will be 
plump, round, and smooth ; and, in many instances, their 
complexions fair and ruddy. Now, this state of things will not 
prevail in those who have the fatal disorders, which hysteria so 
often resembles. Where the disease does not appear to pro- 
duce its proper effect on the system, it is often a just ground of 
hope, that the whole may have arisen from hysteria. 

With one more remark, I shall have done with the resem- 
blances of hysteria toother diseases. Persons who are subject 
to this disease, may of course be attacked by others; and, 
while laboring under these, the paroxysms of hysteria may 
come on, and render it difficult to comprehend the nature of 
the complaint. No rule can be given to guide the practitioner, 
in all these cases. He will be on his guard against supposing 
symptoms in these cases, to be merely hysterical. If, for in- 
stance, the disease occurs in bilious fever, as I have often seen 
it do, he will not overlook the necessity of the powerful reme- 
dies required for the removal of the fever ; and he will be par- 
ticularly guarded against treating such symptoms, as he would 
a common attack of hysteria. The same remark might be 
made in reference to many other disorders ; but the subject 
would be endless, and must be turned over to the sound dis- 
cretion of those who have to manage diseases thus compli- 
cated. 

TREATMENT. 

In the treatment of hysteria, it is to be borne in mind, that the 
mind is often as much concerned in it, as the body. The opin- 
ions, and especially the fears of the patient are not to be re- 
moved by reason, or even by raillery. Yet they are not to be 
encouraged or aggravated. A proper attention to all their com- 
plaints, is necessary and proper ; but it is no advantage to them 
to witness our participation in their fears. Above all, it is our 
duty to treat their complaints with respect, and our patients 
with consideration ; for although there may be no immediate 



510 HYSTERICS. 

danger of death, there are at all times a solicitude and an ago- 
ny, which are entitled to commiseration. 

Few things produce more alarm and confusion in a family, 
than a violent, convulsive attack of hysteria, in one of its mem- 
bers. The first object to be attained, is calmness and self pos- 
session, in the mind of the head, or chief nurse of the house- 
hold. Let every guard against injury be thrown around the 
patient. Let her be held, if necessary, but with the least pos- 
sible constraint. Let her dress be loosened, and admit free air 
into the apartment. Avoid too great a crowd and forbid too 
much interference with her. The first question, is, whether 
she is able to swallow medicine. If she is, give her immedi- 
ately, a tea spoonful of tincture of assafcetida, in water, and re- 
peat it hourly, till the spasms cease — or a tea spoonful of tinc- 
ture of castor, repeated in the same manner — or a tea spoonful 
of spirit of lavender, by the same rule — or thirty drops of laud- 
anum, repeated to the third or fourth time, at hourly intervals, 
if the disease does not sooner subside. These remedies are 
mentioned in the order, in which I think them entitled to con- 
fidence. They may be alternated, according to the taste of the 
patient or her attendants. I often give thirty drops of laudanum, 
and then follow it with assafcetida, or other remedies. But it 
is necessary, to be guarded against using too many remedies at 
a time. Let each remedy have sufficient time to produce its 
effect, before another is administered. Let a time piece be kept 
at hand, for fear will otherwise measure time too rapidly. 
Many other remedies might be mentioned here, but the list 
ought not to be too much enlarged. Musk, camphor, oil of 
amber, and sulphuric ether are remedies of tried virtue, in these 
cases ; and, if no better remedy were at hand, I should ad- 
minister proof spirit, in such quantity as the patient might bear, 
without intoxication. 

When the patient cannot swallow, pungent odorous, or vola- 
tile substances, may be applied to the nostrils, with benefit. 
Camphor and spirit of ammonia, have heretofore taken the 
lead, in such cases. But of late, we have two new remedies 
which have become famous for their effects, when inhaled as 
vapor.. These are sulphuric ether and cloroform. I ven- 
ture, without much experience, to recommend the ether, in ca- 
ses of violent hysteric fits. Pour half an ounce of ether into a 
saucer, and dip a linen handkerchief into it, suddenly, so as to 
allow it no time to evaporate. Take the wet handkerchief and 
apply it over the nostrils and mouth of the patient, so that the 
air she breathes must come through it. Hold the handkerchief 






HYSTERICS. 511 

firmly, and do not let it be put aside ; it will presently become 
agreeable, and the patient will breathe it with great eagerness. 
If* no sensible effect is produced in four or five minutes, take 
another equal portion of ether, and use it in the same way. 
The few experiments I have seen made with this remedy, have 
satisfied me of its great power and perfect safety. It produ- 
ces, in some cases, a temporary excitement ; but, commonly, 
from the first, it produces a calmness, which soon results in 
profound sleep ; this soon passes off, and the patient awakes 
to sensations altogether pleasing and agreeable. I therefore 
recommend it, in violent cases of hysteria ; but the remedy is 
now in the hands of the profession at large, and I may say is 
held in high estimation. I should advise this remedy to be 
used in moderation. Like other powerful narcotics, it is apt 
to become too agreeable to the person w T ho takes it. It re- 
quires the same caution in its use, which should govern us in 
administering opium or alcohol. But there is yet another 
method of administering remedies, to those who cannot, or 
will not swallow them. They may be thrown into the rectum 
by way of injection. Take three tea spoonsful of tincture of 
assafcetida, put it into a gill of cold water, and use it as an in- 
jection — or use in the same manner, tincture of castor, spirit 
of lavender, or spirit of turpentine. These remedies may be 
repeated from time to time, as they may be required. 

Doctor Watson recommends with great confidence, an in- 
jection of ice-cold water into the rectum ; or the application, 
made equally cold, by means of wet towels applied to the pu- 
dunda. The sudden shock of this remedy, has often brought 
to an end the most violent fits of hysteria. I have no experi- 
ence of its use; but think it worthy of a trial, in cases which 
resist other remedies. 

In many cases of hysteria, the symptoms are milder, and 
produce no convulsions, or violent disorder of the body. A 
set of symptoms often present themselves, which perplex 
those who attempt to study them, as much as they annoy the 
patient. The following is an account of the symytoms of a 
single case — "headache ; pain of ears, and occasional deaf- 
ness; frequent loss of voice ; tightness of chest, dry, loud, 
sonorous, and very peculiar cough ; dyseccea ; spasm about 
the throat, with blackness of the face supervening, pain of 
arms ; palpitation, acute pain of the epigastrium, and some- 
times in the left lumbar region; irregular appetite for food, and 
chiefly at night ; costive bowels ; very scanty and high colored 
urine, with copious whitish sediment, but sometimes abundant, 



512 HYSTERICS. 

and pale as water; menstruration quite suppressed, after be- 
ing long defective; much pain of the lower part of the back; 
pain of the legs ; disturbed sleep ; great coldness and insensi- 
bility of the surface, particularly in the lower extremities, 
whilst heat applied to them produces mental excitement, and 
a disposition to loud singing; the palpitations induced by ex- 
ertion, as well as difficult breathing, cough, much agitation, 
and violent crying." Never having taken the pains, to note 
down the numerous similar accounts of symptoms, which I 
have heard from the mouths of my own patients, I have copied 
this from the Encyclopedia of Practical Medicine. Every 
physician of experience, will bear witness of the faithful man- 
ner in which such patients detail their perplexing symptoms. 
But yesterday, I was listening about the tenth time, to one of 
these details, fiom a man in this hysterical mood. When I 
hoped the narrative was over, he said, "I have another symp- 
tom, doctor, of which I have never told you yet." And is it 
possible you have yet another symptom ? said I! Nothing is 
more humbling to the man of science, than these cases. He 
will be asked a hundred questions in an hour, to which he can 
give no satisfactory answer ; and, in spite of his invectives 
against quacks and their remedies, he must prescribe at last 
for the name, and not for the symptoms of the disease. 

I have but little to say in reference to these cases of unde- 
scribed, and undescribable disorders. Hysteria is to be treat- 
ed as hysteria — its train of diffusible, or nervous stimulants, 
must be brought to bear on it, as well as they can. Asafceti- 
da, mush, valerian, castor* and opium, may be used as they are 
demanded, and taken in their turn, in a moderate way. Re- 
member, that time must do something, in these cases. 

Remember also, that inflammation of the spleen and liver, 
dyspepsia, inflamed kidney or bowels, or indeed any other dis- 
ease which hysteria can resemble, may be present when the 
numerous symptoms of this disease are also present. Be not, 
therefore, too confident that there is no danger, when the fears 
of the patient are a leading feature of the case. Few physi- 
cians will deny having fallen into such mistakes. The dan- 
ger is often present, when we least expect it. It is only neces- 
sary to say, that when a dangerous disease is present w 7 ith hys- 
teria, the treatment of the most dangerous disease is the first 
consideration, and that these diseases are treated of under their 
proper heads. 

I follow able writers in considering in this place certain 
strange disorders, which have been called hysterical. I know 



HYSTERICS. 



513 



not how else to dispose of them ; but they resemble any thing 
else as much as hysteria. 

I will mention without much comment, certain disorders of 
sympathy, or, as it has been termed, imitation. Fits of hys- 
teria, have been propagated in this way, so as to fall on several 
of one family, in quick succession. Whole wards of certain 
hospitals, are reported to have been thrown into confusion, 
from the same cause ; and I have some where read an account 
of a nunnery, whose inmates were almost all seized in the same 
way, with convulsions. These cases must arise from move- 
ments first made in the mind ; and, in this respect, they differ 
I think from hysteria. There is no setting limits to the power 
or influence of the mind. The community in which I reside, 
was once shocked by a popular citizen, walking into his gar- 
den under the rays of a beaming sun, applying a pistol to his 
head , and blowing out his brains. The next day another person 
performed the same deed, and at night a third attempted to cut 
his own throat. These strange things arise from moral cau- 
ses, and are arrested by a change in the direction of the same 
causes. The old English law which punished suicide, by re- 
fusing christian burial, and abusing the dead body of the per- 
petrator of the horrid deed, was a powerful means of prevent- 
ing such a crime. The fear of being exposed and ducked in 
cold water, is said to have stopped a contagious and spasmod- 
ic disorder-, which at one time prevailed, in an English county. 
And it is only necessary here to say, that when these disorders 
invade a community, they are under the control of a powerful 
and united public sentiment. These horrid acts, and strange 
fantastic tricks, cannot face public scorn and reproach. If 
sympathy can cause these things, sympathy can also cure 
them. The sects and denominations of fanatics, which have 
combined on principles subversive of human happiness, have 
withered before the contempt of men. 

There is another class of these disorders, in which the mind 
is chiefly affected. The patient will take it into her. head, that 
she is paralysed and cannot walk ; or that some joint or bone 
of her body is diseased. Every conceivable pain may also be 
complained of, and the case seem hopeless ; and yet, by a pow- 
erful effort of the will, the patient may rise and go her way. 
This form is not entirely confined to the female sex. I have 
known a man who having kept his bed for three years, arose 
and was well without remedy or the pretence of it. Such ca- 
ses are often in this way recovered from, and the physician, to 
his great delight, relieved from fruitless investigations. In 
33 



514 HYSTERICS. 

other instances, powerful moral causes are brought to bear on 
them ; their faith, or their fears, or their hopes, are excited, 
and they are relieved, as if by miracle. The great difficulty is, 
to know these complaints from the alarming diseases they re- 
semble. Judgment should alwa}^s lean on the side of charity, 
in these cases ; and severe measures ought not to be taken 
hastily. 

In large hospitals, these patients have been treated with 
great harshness. The cold douche has obtained great reputa- 
tion, in the treatment of such cases. This remedy is a power- 
ful current of cold water, thrown on the patient, and qualified 
to alarm and terrify, if not to cure. In this way, it is said, sud- 
den relief has been obtained from symptoms resembling locked- 
jaw, and in other cases, sudden motion given to limbs long 
thought by their owners to be paralysed. In other instances, 
injections of iced water have been made into the bowels, with 
great perseverance ; and, it is said, with the happiest effect. 
These remedies are so used, as to make the most powerful 
impression on the mind and body, at the same time. Such 
remedies ought not to be used without mature deliberation. 
They carry with them pain and suffering, and may do harm 
where improperly prescribed. The accounts we read, of their 
administration in certain hospitals, remind us of any thing rath- 
er than an institution of charity. They look more like the 
punishment of one of Don Quixot's unfortunate knights, who 
was cruelly punished by having given to him injections of 
" snow water and sand." 

Strictly speaking, hysteria is not a disease of paroxysms, 
but continues all the time with symptoms, sometimes of little 
moment, but, at others, rising suddenly, even to convulsions. 
For the treatment of the graver and more alarming symptoms, 
I have given my advice. But for those which continue, and 
produce less disturbance, a word or two may be necessary. 
The choking which becomes almost habitual, and is endured 
in silence by thousands of the afflicted, is relieved by assa- 
foetida. The most convenient, and least offensive way to use 
the remedy is in pills. Two pills of about four grains each is 
a common dose, and may be repeated several times a day. 
Those who cannot swallow the pills may take a tea spoonful 
of the tincture of asafcetida, or of castor in their place. These 
remedies are offensive, and communicate to the breath their 
offensive odor. To avoid this, tincture of valerian, or spirit of 
lavender, may be substituted. Now these are the best reme- 
dies we have for hysteria, and are to be used according to cif- 



CATALEPSY. 515 

cumstances, while it lasts. But they are not remedies for the 
other diseases under which such patients may labor. A de- 
rangement of the function of menstruation, is a common atten- 
dant, and is to be treated as if it were a separate disease. Ir- 
regular action of the bowels, is also to be treated for itself; but, 
in such cases, a course, stimulating and tonic, is proper. Pills 
of aloes and gamboge, are a good cathartic, in these cases. 

SUMMARY OF THE TREATMENT OF HYSTERIA. 

In the first place, when the attack is violent, and attended 
with convulsions : 

1. Secure the patient from injury, during her struggles. 

2. Give assafcetida. A tea spoonful of the tincture in water, 
hourly, till the convulsions cease. A larger dose may be given 
in severe cases. 

3. It the patient objects to assafcetida, give tincture of castor, 
tincture of valerian, or spirit of lavender, in the same manner 
and quantity. 

4. Laudanum, or opium may be given in place of the above ; 
but it is less to be relied on. From thirty to forty drops of 
laudanum, or one or two grains of opium may be given, hourly, 
till two or three doses are given, if the disorder does not soon- 
er give way. 

5. If no other stimulant is at hand, give proof spirit, or wine. 

6. Where the case becomes chronic, and the symptoms mil- 
der, they are still to be treated with the same remedies, re- 
peated from time to time, according to circumstances. 

7. Keep the bowels regular by the occasional use of a pill 
or two of aloes and gamboge ; and, if there are symptoms of 
disordered liver, give three grains of calomel with the pills. 

8. In all cases complicated with, or happening in other dis- 
eases, let the remedies be directed to the removal of the most 
dangerous, rather than the most disagreeable disease. 

9. Be guarded against treating hysterical patients with 
harshness or cruelty. No human affliction is entitled to more 
sympathy. 



CATALEPSY. 

This is one of the most astonishing forms of nervous dis- 
ease ; it is said to occur chiefly in hysterical women ; but the 
two cases which I have witnessed, both occurred in per- 



516 CATALEPSY. 

sons affected with mania, and one of these was a man. The 
affection, although most awful to behold, is not considered dan- 
gerous ; it presents itself under some variety of symptoms, 
and has stood for the original, in many a romantic tale of tran- 
ces and supernatural visitations. It occurs so rarely, that ma- 
ny have disputed its existence. 

In catalepsy the patient is fixed, motionless, and senseless ; 
the circulation of the blood is feeble, and the breathing so gen- 
tle, that the person has all the appearances of a corpse. In 
some cases, the similitude of death has been so perfect, as to 
have led to the interment of the patient alive. In the instan- 
ces which I have seen of the disease, there was but little dan- 
ger of mistaking the case for real death ; for the pulse, though 
feeble, was still obvious, and the breathing was not entirely 
suspended ; still the stiffness of the limbs resemble, in a great 
degree, the common stiffness of a corpse. 

The symptoms of catalepsy, are as readily understood by 
the description of a single case, as perhaps by any other mode 
of describing it. A lady of high endowments, and high toned 
nervous system, became insane, her disorder continued for 
some months, and she seemed to be sinking into fatuity. One 
morning she was found in her bed, to all appearance a stiffen- 
ed corpse ; yet it was obvious that life was not quite extinct. 
I was called to see her, and found her lying on her back, with 
all the appearance of death, except that there was evidently 
some circulation of the blood, still going on — she was not as 
pale as a corpse. On taking hold of her wrist, the pulse was 
distinctly felt beating, about one hundred times in a minute. 
On attempting to lift her hand, the arm was found to be stiff; 
and, on applying sufficient force, it was raised up, as if she 
had reached as high as she could ; on letting go the arm, it re- 
mained in this position, as if held there by a strong effort of the 
will. These experiments w r ere varied from time to time ; and 
it was found, that although the stiffness was so great, as to re- 
quire considerable force to move the limbs from this elevated 
position ; they yet would gradually settle back to the positions 
from which they had been taken. Nothing could be more aw- 
ful than she appeared, when both arms had been forcibly raised 
and extended, her eyes opened, and her head raised from her 
pillow, as if she w r ere in the act of rising. In this position she 
would remain to all appearance fixed, and immovable ; for, 
with the closest observation, }~ou could not discover in her the 
slightest tremor, or motion of any kind. She looked still and 
immoveable as the sun ; yet like the sun, her head and her 



CATALEPSY. 517 

limbs were descending to their place. In little more than half 
an hour, with a motion so gradual and steady that you could 
not perceive it, her eyes would close, her head descend to its 
pillow, and her hands to their resting place, at her sides. It 
was found impossible to pour any thing down her throat, and 
she continued in this state so long, that death, from starvation, 
was seriously apprehended. She was now in reduced cir- 
cumstances, and her few attendants had become weary. One 
morning it was discovered that she had been up in the course 
of the night, and had eaten something which had been acciden- 
tally left in her reach, but she was found in her bed, in the 
same circumstances as before. I was again called on to wit- 
ness the reality of her cataleptic condition ; it was the same I 
had before witnessed, and wholly impossible to have been 
voluntarily assumed. Food was now placed \vithin her reach, 
and she arose about midnight every night, to partake of it. 
She w T ould never arise for this purpose in the presence of any 
one, nor if there was a lighted candle in the room. I believe 
her system and manner of rising and eating in secret, were 
never detected. Her recovery from this state was very gradu- 
al, and I believe was never perfect. She w T as removed to a 
distance from me, and I never ascertained the particulars of 
the conclusion of the case. 

I will mention another case of this singular disease. An in- 
sane man was affected with this rigid state of the muscles, and 
almost apparent death. His pulse was, however, not very 
much reduced ; he breathed audibly enough, and could swal- 
low a small portion of any liquid poured into his mouth ; he 
was a youthful, vigorous, and very powerful man, and had in 
the beginning of his insanity, been treated w 7 ith great harshness 
and cruelty. His attack of catalepsy came on suddenly, but 
was at first partial. Placed on a seat, he would sit there all 
day ; placed in bed, he would remain until taken up again. It 
was curious to observe him propped against a wall, or moved 
from place to place like any piece of lumber, but without any 
motion of his own. He was, in this state, placed in the lunatic 
asylum, near Milledgeville, where he remained for many 
months without much improvement. At last, it was announc- 
ed, that he had, in some degree, recovered. I examined him 
and saw him take his food ; but some time afterwards he made 
his escape from the institution. After many days, it was dis- 
covered that he had some how, made a journey of one hundred 
and sixty miles, where he reached the residence of some of his 
relations ; but his recovery was still imperfect. Now nothing 



518 CATALEPSY. 

can be conceived which would look more improbable, than 
even the partial recovery of this man. His catalepsy had last- 
ed for nearly two years. I myself saw him a great many 
times, during that period; and his appearance, during the whole 
time, was such as to warrant the opinion, that even a partial 
recovery would be nearly impossible. 

These cases do not comprise all the symptoms of catalepsy. 
The disease has not so often been seen in persons affected 
with madness, as in those subject to epilepsy, lethargy, or 
other nervous disorders. Its varieties cannot be estimated, 
and the manner in which it may exist in connexion with other 
nervous disorders, is little understood. The disease is said to 
attack suddenly, and pass off in the same wa}^, but to recur in 
paroxysms. The patient is not always insensible, and some- 
times such persons have a distinct remembrance of every thing 
which transpires around them, during the paroxysm. A story 
is told of a lady, who, in this state, witnessed with horror, the 
preparations which were going on for her interment, but still 
her inability to move continued. The only symptom which I 
think peculiar to it, is the waxy, or corpse-like stiffness, which 
pervades the whole frame ; so that a limb bent in any direction 
stands immoveable, or nearly so. This state of the muscles, 
does not occur in any other disorder. 

TREATMENT. 

The treatment of catalepsy is by no means agreed on ; its 
occurrence is so rare, that no one can be said to be experienced 
in its management. In the intervals which usually happen, 
there is an opportunity of giving remedies. I advise the ner- 
vous stimulants, assafcetida, castor, or spirit of lavender, in full 
doses, repeated once in two or three hours. If the interval is 
long, tonics should be added. Tincture of gentian may be 
taken in doses of a tea spoonful four or five times a day. A 
pure stimulant of proof spirit may be given at discretion. 

During the paroxysm when nothing can be administered 
which is to be swallowed ; apply sinapisms to the spine and to 
the arms and legs. Do not let them remain on long enough to 
draw a blister. 

Writers advise bleeding, cupping, or leeching, in cases in 
which the face is flushed, and the pulse strong in the arteries 
of the neck. I think such cases will not be likely to occur. 
Till I see one such, I shall not advise bleeding in any way. 

I say nothing of the general treatment of patients, who have 



NERVOUS PAIN OF THE FACE. 519 

had paroxysms of catalepsy. If they have other disorders, 
they will be treated with but little reference to catalepsy, and 
it should not be forgotten, that with all its horrid symptoms, 
this disease is seldom fatal. 



NERVOUS PAIN OF THE FACE— TIC DOULOUREUX. 

This is a disease of middle life, and seldom met with in 
persons under forty years of age ; yet a few rare cases of it 
have happened in children, of nine or ten years of age. 

The disease is known by a pain which occurs very sudden- 
ly in some part of the face, commonly in the upper part of 
one of the orbits of the eye. It is not always confined to the 
face, for the worst case of it which I ever witnessed, was de- 
scribed to me, as attacking a spot not larger than a quarter of 
a dollar, an inch or two above the ear. The pain in the face 
is attended with twiching, or sudden movements of the mus- 
cles ; wherever it happens, the patient shrinks from it, as if 
he had received a blow : it is compared to the pain from stab- 
bing. Few pains are more violent and intolerable ; but, fortu- 
nately, they are not apt to continue very long without remis- 
sion. In some cases, however, the disease proves exceeding- 
ly obstinate, returning at uncertain intervals, and rendering the 
patient's life a burthen to him. The disease is attended with 
no inflammation or tenderness ; on the contrary, the patient 
often seeks relief by making violent pressure in the immediate 
seat of the pain. 

TREATMENT 

The causes of this disease are exceedingly obscure, and its 
treatment very uncertain. Where there are regular intervals, 
a very strong reliance may be placed in the sulphate of qui- 
nine. Divide sixteen grains of quinine into eight pills ; give 
one every hour, till the whole are taken. This is a full allow- 
ance for one day, and should be so timed, as to be finished an 
hour before the expected paroxysm. Where the disease re- 
turns at uncertain intervals, this remedy is less to be relied on ; 
for it cannot be continued 'beneficially for a great length of 
time. If it does not succeed in two or three days, it should be 
abandoned. Opium is a remedy which cannot well be dis- 
pensed with, in the treatment of these nervous pains. Sixty 
drops of laudanum, or half a grain of morphine, may be given 



520 NERVOUS PAIN OF THE FACE. 

at the onset of ihe disease. These doses mav be increased in 
extreme cases. I have administered double the quantity here 
recommended. This remedy affords but a temporary relief 
in this disease ; it should not be indulged in without necessi- 
ty, nor forborne where the consequence is a long paroxysm of 
intolerable pain. Where the disease has considerable inter- 
vals, arsenic has been found useful, used in place of quinine. 
Ten drops of Fowler's solution ma} r be given, three or four 
times a day. If it produces nausea, or pain in the stomach, 
the dose may be lessened. This remedy may be given at an} r 
time during the interval, or in the paroxysm, and may be con- 
tinued for a week or ten days if necessary. Cathartic medi- 
cines have been recommended, and should have a trial in this 
disease. They should not be given on the same day with qui- 
nine, or too near the time at which laudanum may have been 
taken. Take of calomel, ten grains, gamboge, two grains ; 
make into pills, and give all at once, as a cathartic. Or take 
of aloes, ten grains ; calomel, four or five grains ; and gam- 
boge, two grains ; make these into pills, and give all at a single 
dose. This last cathartic is especially proper, where the bow- 
els are constipated, and there is good reason for supposing the 
liver does not perform its functions properly. 

A great variety of local remedies have been recommended 
for this obstinate disease. Blisters, sinapisms, tartarized an- 
timony, and I know not what else, have been tried and some- 
times found beneficial. Take of tartar emetic one drachm, 
and rub it into about twice its weight of simple ointment ; rub 
it on the seat of the pain, and to some extent on the surround- 
ing parts, till its peculiar inflammation, with pustules, is 
brought on. Or apply a blister over the part, and let it remain 
until fully drawn. These, and similar applications, may be 
varied to almost any extent ; heat by vapor, or even dry, has 
been found sometimes beneficial. 

I confess I have not much faith in local remedies for nervous 
pains ; nor have I much more confidence in general depleting 
remedies of any kind, whether it be the use of the lancet, or 
emetics, or cathartics. My chief reliance is on the quinine, 
arsenic, and opium, I have recommended ; but where the case 
proves obstinate, and these remedies have been used till they 
have been found not to be beneficial, I advise a resort to a gene- 
ral course of tonic and restorative remedies. Of these reme- 
dies, preparations of iron occupy the first place. Twenty 
drops of the muriated tincture of iron, may be given in water, 
three times a da} T ; or ten grains of the carbonate, or red pre- 



HYPOCHONDRIA. 521 

cipitated carbonate of iron, may be given also three times a 
day. Other metalic tonics have been recommended ; but I 
give a decided preference to those I have mentioned. The 
vegetable tonics are also proper in these cases. The extract of 
gentian, made into pills of four grains, by combining it with 
powdered ginger, is perhaps one of the best. Three or four of 
these pills may be given, in the course of the day. The com- 
pound tincture of gentian, in doses of a tea spoonful in water, 
three or four times a da}', will also be proper. 

Combined with these, a moderate use of wine, porter, or 
brandy, may be made where the strength of the patient is so 
much exhausted, as to require the aid of these stimulants. 

We take leave of tic douloureux, without recommending 
the questionable surgical remedies, which have been recom- 
mended for it. The disease is, I believe, seldom, if ever, fa- 
tal. It is, however, sufficiently obstinate, to make the physi- 
cian doubt the efficacy of his remedies, as much as he will 
dread the sight of his patient. 



HYPOCHONDRIA— HYPOCHONDRIASIS. 

" Hypochondriasis, or the hypochondria malady, is a dis- 
ease in which symptoms of dyspepsia, such as flatulence, eruc- 
tation, with a sense of uneasiness in the stomach, and hypo- 
chondre, are combined with a remarkable lowness of spirits, 
or a desponding habit of mind, and a constant disposition to 
attend to every minute change in the bodily feelings, and to 
apprehend extreme danger from the most trifling ailments." 
It has never been settled whether this is chiefly a disease of 
the mind, or of the body. That its S}' r mptoms often strongly 
resemble the most formidable diseases, is certain ; but that it 
is, in the main, unattended with serious danger, is equally 
certain. 

It is important to know hypochondria, wdien we meet w 7 ith 
it ; and this will not always be found an easy matter. The 
patient will often be found to present the appearance of sound 
health ; yet he fancies himself the victim of some fatal disor- 
der ; and will describe symptoms which it will frequently be 
difficult for the practitioner to comprehend. These symptoms 
most frequently relate to the state and condition of the alimen- 
tary canal. Pain, costiveness, acid eructations, and other 
similar symptoms which the patient will detail with fatiguing 



522 HYPOCHONDRIA. 

minuteness, are very common. Yet there is very little, if any, 
fever present ; but the tongue may have on it a slight brownish 
coat. The appetite is exceedingly uncertain, sometimes being 
voracious, at others, having a loathing for food, and frequently 
great pain and uneasiness at the stomach, after eating. In 
other cases, the symptoms are still more severe. A sense of 
violent distention, with sudden pain, is felt in various parts of 
the bowels ; and is but partially relieved by the discharge, of 
large quantities of air, from the stomach or intestines. 

As the case advances, the nervous system appears to be- 
come extensively involved. Violent pain attacks the head, 
sometimes intolerance of light, with vertigo or giddiness, and 
other indescribable sensations, wmich become, in some cases, 
too intolerable to be borne. These pains and symptoms of 
uneasiness, come on in paroxysms, when to hear the patient's 
account of his sufferings, they would frequently seem sufficient 
to destroy him, if he had a thousand lives. Great perturba- 
tion usually attends these attacks, wmich frequently occur in 
the middle of the night, when the patient, after having passed 
several hours in vain efforts to sleep, suddenly takes up the 
notion that he is dying, or about to die. 

Great excitement of the mind, is almost always present in 
hypochondria. The patient is not insane, but exaggerates eve- 
ry symptom, and magnifies every pain that he feels. He will 
fashion up his array of symptoms, so as to demonstrate in his 
own mind, the impossibilit} r of his recovering from the disease. 
He will frequently express himself as being weary of life ; but 
no one takes greater care, or swallows more remedies to pre- 
serve it. Such patients search for remedies with great eager- 
ness, and willingly try every nostrum which is offered to them ; 
they are the great supporters of quacks, and the venders of 
quack remedies. 

There would be no end to the detail, if we should attempt 
to set down all the aches, and pains, and ills, of our hypochon- 
driac patients. Palpitation of the heart, intermitting pulse, 
difficulty of breathing, and other alarming symptoms, counter- 
feit, but too well the numerous, fatal diseases to which the 
heart and lungs are subject. If the patient reads medical 
books, his accounts of his symptoms will often be so exactly 
like those which affect persons in the most fatal disorders, that 
the physician who is not very much on his guard, will be often 
deceived by them. It is an acknowledged fact, that many ca- 
ses of hypochondria are thus mistaken for the most fomidable 
diseases ; the patient is carried through the most tedious pro- 



HYPOCHONDRIA. 



523 



cesses of medical treatment ; and it would be a great pleasure, 
it' we could say with truth, that such treatment is not oftener 
pernicious than otherwise. 

Enough has been said to render it obvious that there will 
often be great difficulty in discriminating hypochondriasis from 
other diseases. Between it and hysteria, the line of demarca- 
tion will often be difficult. It is far from being certain, that 
they are not the same disease. It is true that hysteria has been 
considered a disease of females, and the globus hystericus, or 
choking, which is its characteristic symptom, belongs almost 
exclusively to the female sex. It is also true, that the spasms 
and violent convulsions which follow in their train, are not 
known as symptoms of hypochondria. But in spite of these 
differences, there is so much resemblance between these dis- 
eases, that it is not always possible to discriminate between 
them. This is, however, a matter of no very great impor- 
tance, for the treatment of the two disorders is not very dis- 
similar. 

But the greatest difficulty which presents itself in the treat- 
ment of this disease, arises from its complication with other, 
and more fatal disorders. A patient afflicted with h3 r pertro- 
phy of the heart, dropsy of the lungs, colic, or other serious 
disorders of the vital organs, may, at the same time, be labor- 
ing under hypochondriasis. No rule can be given for the dis- 
crimination. The physician should be on his guard, against 
treating his hypochondriac patients too carelessly. Their 
complaints, if not very dangerous, are very annoying; and to 
whom should they look for aid or sympathy, if not to their 
medical attendants ? The candid physician of experience, 
will not fail to acknowledge, that the dangerous diseases which 
are frequently complicated with hypochondria, are frequently 
so obscured by it, that it is almost impossible to detect them. 

TREATMENT. 

Few diseases are more difficult to treat properly, than hy- 
pochondria; because it is seldom an unmixed disease. Where 
the patient has the appearance of health, and no disease of any 
particular organ can be detected, his remedies are to be direct- 
ed, in a great degree, by the influence they will exert on the 
mind. A radical change of habits and pursuits, will probably 
effect more, than any medicine which can be given. If the 
patient leads a sedentary life, and is a student, let him lay by 
his books, and take severe or violent exercise. This may be 



524 HYPOCHONDRIA. 

done on foot or on horseback, or if it is preferred, some labo- 
rious occupation may be entered into, till the disease disap- 
pears. Travelling has probably proved a remedy in more ca- 
ses of this description, than any thing else. The summer ex- 
cursions to watering places, have been recommended from the 
earliest times ; and such patients have been told to disregard 
the irregularity in diet to which a life passed in country tav- 
erns, or fashionable boarding houses, might expose them. It 
would be impossible to lay down rules on this subject, which 
would be applicable to every case. The sound discretion of 
the physician and friends of the afflicted, will be their best 
guide. One thing I would wish particularly to enforce on this 
subject ; and that is, that a change of habit or pursuit is the most 
important of all 'prescriptions. The patient must be torn loose 
from his habits of thought, and of action. I have seen a poor 
woman, who was borne down by the labor of providing for, 
and rearing a number of children, restored by being for a time 
withdrawn from the drudgery of her occupation. 

But it is impracticable to limit our efforts in the cure of hy- 
pochondria, to the mere influence of moral agents. There are 
few cases in which there will not be a reasonable necessity for 
remedies ; and there are probably still fewer, in which the pa- 
tient could, for any length of time, be induced to abstain from 
the use of them. His feelings assure him, that he labors under 
an awful affliction ; and he would consider it little less than 
self-destruction, to neglect the use of remedies. A few gene- 
ral rules on this subject is all that we can offer. 

1. The first rule is, to administer such remedies as will 
maintain a regular and proper action of the alimentary canal. 
Such patients are seldom regular in their bowels ; they have 
sometimes a great formation of acid, which passes off their 
crude and ill digested food, like diarrhoea ; but far more fre- 
quently, the bowels are habitually costive. This costiveness, 
or diarrhoea, shows equally the imperfection with which the 
organs of digestion perform their functions. The matters dis- 
charged are usually pale or ash-colored ; although the}?" are 
sometimes found to be of an uncommonly dark color. The 
same remedy may be used for the correction of these appa- 
rently inconsistent states of the bowels. A mild laxative pill, 
formed of aloes alone, is well suited to these cases. A single 
pill may be taken at night ; and if the bowels are not acted on 
in the morning, another. This may be repeated, from day to 
day, as long as circumstances require. Two or three grains 
of calomel may be added to these pills, if the bowels are unu- 



HYPOCHONDRIA. 525 

aually torpid, or if the diarrhoea is troublesome ; and it will be 
found on trial, that this remedy will tend to produce a regular 
action of the bowels, whether they had been previously affect- 
ed with diarrhoea, or costiveness. These remedies, should not 
be persisted in longer, or repeated oftener, than the symptoms 
of the case require ; the calomel especially, it should be recol- 
lected, ought not to be given often enough to endanger a sali- 
vation. Where the bowels are tender, and, especially, where 
there are symptoms of piles, the pills of aloes ought not to be 
given ; but other cathartics substituted. Rhubarb and mag- 
nesia, are perhaps the best. Equal quantities by weight, of 
calcined magnesia and rhubarb, may be rubbed together, and 
a tea spoonful of the powder, taken in water, as often as it may 
be found necessary. These, or other mild cathartics, may be 
used to accomplish the design, of keeping in a regular condi- 
tion the bowels of hypochondriac patients. They may be sub- 
stituted by other similar remedies, without any manifest dis- 
advantage ; but I should object to the use of any kind of salts, 
or of jalap, or other active cathartics. 

2. The next class of remedies which I advise in these cases, 
is composed of those which have been denominated nervous 
stimulants. The principal of these, are assafcetida, castor, 
musk, valerian, &c. The doses and manner ot using these 
remedies need not be repeated here ; they are particularly 
useful where the bowels and stomach are oppressed by wind, 
and there are wandering pains and cramps felt, in various parts 
of the body. These remedies are offensive and unpopular ; 
but they afford the best means we have of combatting the un- 
pleasant symptoms of these disorders. I believe they are not 
much advised by medical men ; but from my own experi- 
ence, I have no hesitation in recommending them. 

3. In the third place, it is necessary to observe, that there 
are many cases of this disease in which there is a low, inflam- 
matory fever present, all the while. This state of things is of- 
ten founded on local disorders, too inconsiderable, or located 
on organs too remote from observation, to admit of our perceiv- 
ing them. It is soon, however, made manifest by the effect of 
our remedies. Any stimulant which is administered, will be 
found to produce disorder of the stomach, with increase of all 
the symptoms of the disease. Very frequently, even a glass 
of wine, will be thrown up from the stomach. Such cases 
were treated with some success by the celebrated physician, 
Broussais, who considered a low inflammation of the stomach 
and intestines, as the foundation of this, as well as many other 



526 RHEUMATISM. 

disorders. His remedies were few and simple ; the applica- 
tion of a few leeches about the pit of the stomach ; the use of 
an occasional injection, and a diet almost entirely composed of 
thin gruel, or gum water. These remedies are, I have no 
doubt, well adapted to the cure of some cases of hypochondria. 
The few cases in which I have tried them, have given me a 
good opinion of their efficacy. I think there is no particular 
advantage in the use of gruel, or gum water. These are mere 
modes of restricting diet. A little rice, or hominy, given two 
or three times a day, will answer fully as well, and prove much 
more agreeable to many individuals. 

4. Lastly. Recollect that hypochondria is commonly con- 
nected with some other disease, and that the remedies neces- 
sary for that disease, should not for a moment be lost sight of. 



RHEUMATISM. 

This disease has been divided into two varieties, the acute 
and the chronic, both affecting the same parts or tissues — at- 
tacking the joints, especially the larger ones, and other parts 
of the body where a similar structure prevails. The disease 
is not a common inflammation, but specific ; running a course 
peculiar to itself, which sufficiently distinguishes it from every 
other inflammation. It affects what is termed the fibrous tis- 
sues, particularly the ligaments that surround the joints. Be- 
sides this, its attack is often felt on the fibrous tissues about the 
heart, where it becomes a most formidable disease. This in- 
flammation, although sometimes very intense and acute, is lit- 
tle disposed to produce suppuration, or gangrene. Although 
adjoining parts may suppurate, those particularly affected by 
this inflammation, will still remain without that occurrence. 
The same fact holds good in chronic rheumatism. Here the 
disease may continue for a great length of time, and consid- 
erable alteration takes place in the structure of the parts, with- 
out suppuration or mortification. 

Acute rheumatism produces the ordinary phenomena of 
acute inflammation, redness, heat, pain, swelling. It is gen- 
erally seated near the larger joints, and is subject to be trans- 
ferred suddenly from joint to joint, or to internal organs, es- 
pecially the heart. This peculiar inflammation is attended 
with a high degree of inflammatory fever, very full pulse, 
flushed face, headache, profuse, sour perspiration, and a white 



RHEUMATISM. 527 

tongue, red at the tip. The urine is at the same time turbid, 
anil acid. The fever continues inflammatory, seldom, it" ever 
running into the typhus form. It seldom produces delirium, 
vomiting, diarrhoea, or petechia ; but when transferred to the 
heart, the disease assumes its most malignant symptoms, and is 
sometimes attended with delirium. 

Great tenderness attends this disease. Motion in the part 
affected is exceedingly painful ; but even in a state of rest, the 
pain is, in many instances, exceedingly severe. The painful- 
ness attending motion may be considered characteristic ; for 
although the patient be in the greatest agony, he will be com- 
monly strictly confined to a single position which he may 
choose as the easiest. Swelling is also a common symptom, 
and is scarcely absent in any cases of acute rheumatism ; but 
the redness which naturally belongs to inflammation is seldom 
seen on the surface, for the disease confines itself, as I have 
stated, to the ligaments below. The symptoms of this disor- 
der admit of considerable variety. The parts affected by it, 
arenot always exactly the same — in some cases it seems to 
penetrate the joints, and attack the membrane with which they 
are lined. In others, the inflammation appears more diffused, 
and extends to a greater distance from the joints. These ca- 
ses sometimes involve the surrounding tissues, producing, in 
some instances, suppuration, and other changes in the sub- 
stance of the part. This diffused rheumatism, as it has been 
termed, presents the most violent and dangerous cases of the 
disease. When it is confined to the joints, the danger is far 
less. The resemblance to gout, in this disease, is striking. Its 
migratory character is the same ; but to rheumatism especially 
belong the larger joints, the gout attacks the smaller. The hab- 
its of individuals attacked by this disease, may also give us a 
clue to a proper judgement. Those who are most exposed to 
the inclemency of the weather and great fatigue, are most sub- 
ject to attacks of rheumatism. Causes the reverse of this, 
predispose to gout. Youth and middle age are the periods of 
life most subject to attacks of rheumatism. In small children 
the disease is rare, but peculiarly dangerous ; for in these its 
liability to attack the heart is greatest. 

TREATMENT. 

No disease has been more fruitful of disagreement than 
rheumatism. While one will advise the use of the strongest 
stimulants, bark, opium and others of like kind, another will 



528 RHEUMATISM. 

tell you that these remedies are utterly destructive, and that 
bloodletting and calomel are the principal remedies. The 
disease, in its acute form, generally terminates favorably, 
sometimes producing stiffness in the joints. It terminates 
usually in five or six weeks, even when left to itself. The con- 
test over, the remedies suited to its treatment are not yet over. 
Quinine has its violent supporters, and remedies apparently the 
most opposite, are equally in favor with others ; I am reduced 
therefore, to the necessity of stating my own practice. 

If called to rheumatism within the first week of its attack, 
where the inflammation runs high, and the pulse is full and 
bounding, I do not hesitate to abstract blood to the extent of ' 
eighteen or twenty ounces. Without loss of time I adminis- 
ter a decidedly effective dose of opium in some form ; the 
celebrated Dover's powders in preference to any other. Di- 
vide thirty grains of this into three powders, and administer 
one hourly, till the three are taken — a full anodyne effect may 
be expected. Twelve hours' quiet rest, with great freedom 
from pain, is a common consequence of this treatment. True, 
the pain frequently returns, sometimes with symptoms but lit- 
tle mitigated, but I do not hesitate to repeat the same course. 
More commonly, however, I omit the bloodletting at the second 
prescription, and use the Dover's powder by itself. It is no- 
torious, that spontaneous perspiration affords no relief, not 
even at the moment, to rheumatic patients ; but a perspira- 
tion very copious brought on by the remedy 1 have advised, I 
have found attended with the greatest degree of comfort. If 
the disease continues without very great abatement, my plan 
is, to add calomel to the opium and administer at least ten 
grains of this remedy within the space of two days. Should 
no cathartic effect be brought on by the calomel, other mild 
cathartics may be employed, castor oil is perhaps the best. 
These remedies are to be continued until the disease gives way, 
unless the strength of the patient appears to give way. Where 
debility becomes manifest, although the pulse may be still to 
a considerable degree inflammatory, stimulants and tonics, 
judiciously used, are recommended. Here I should not hesitate 
to use the sulphate of quinine, to the extent of ten or fifteen 
grains per day. Nor should I fear the occasional use of bran- 
dy and water, having due regard to the time of administering 
it, and choosing that in which there is least fever. The acid 
state of the urine and perspiration has suggested the internal 
use of the alkalies, and I believe them to be beneficial. Car- 
bonate of soda is the most convenient of these, and may be 



RHEUMATISM. 529 

taken in closes of ten grains, dissolved in water, from three to 
six times a day. 

I have said nothing of local applications, for they have prov- 
ed exceedingly inefficient. Still I can readily conceive, that 
where the disease is a little protracted, and runs into that state 
which some have termed subacute, local remedies find a 
proper place in the treatment. The best of these I have no 
doubt, are the most soothing; such as emolient poultices, warm 
fomentations, &c. The application of blisters, leeches, and 
other similar remedies, if made at all, should be at some dis- 
tance from the seat of inflammation and not exactly on it ; for 
1 have observed that over a surface so intensely inflamed, a 
blister will scarcely be made to operate at all ; and if it does 
detach the cuticle, it will not fill with the ordinary serum found 
in blisters, but with a thick gelatinous substance which will 
soon cease to flow, and produce but little benefit. 

I have advised the use of calomel in broken doses, in this 
disease, but do not consider it desirable that it should be so 
used as to produce salivation. I should therefore not continue 
it for many days, together, although it will be found when 
combined with the remedies, exciting the copious perspiration 
we have so frequently alluded to, that a salivation will not be 
easily brought on. It is little to be feared from the use of this 
remedy, which a prudent practitioner may make. 

CHRONIC RHEUMATISM. 

Of chronic rheumatism there are two varieties, one which 
has a commencement like the acute kind, and does not give 
way, but runs on to the most interminable chronic variety. 
It is interminable, attended with moderate swelling, heat of 
the parts, and becomes, in its course, very much diffused, at- 
tacking the smaller as well as the larger joints. The treat- 
ment of this variety differs only in degree, from that which we 
have above detailed. The remedies cannot be concentrated 
in such force, and endured for such a length of time, as this 
modification of the disease might require. 

The other variety of chronic rheumatism has been termed 
the passive. Very little swelling or soreness of the parts is 
produced by this disease. On the contrary, the pain which is 
often very extreme, may be relieved Jby pressure, or by violent 
friction. Warm applications, even in a dry form, afford great 
comfort to such patients ; and perspiration, when induced, ap- 
pears to afford them relief. This form of the disease frequent- 
34 



530 GOUT. 

ly continues through the winter, giadually giving way, as 
the warmth of summer prevails. Sometimes it attacks the 
bones, producing swellings on them which have been termed 
nodes. It seldom, however, produces the destruction of the 
joints, so common in the forms we have been considering. For 
this form of rheumatism, I have of late seen the iodide of po- 
tassium, in doses of live grains, three times a day, highly re- 
commended. [ have no experience of its use in these cases, 
but do not hesitate to recommend the remedies which I have 
used. These are principally Dover's powder, from time to 
time, with such small doses of calomel as may be prudently 
used without exciting a high degree of salivation. Two grains 
a day of calomel, may be used for any reasonable length of 
time. 



GOUT. 



Gout is the child of luxury. I have met with but few cases 
of it, within the range of my practice; because, as I think, 
the citizens of the South, are an exceedingly temperate people. 
This temperance of ours extends especially to the use of fer- 
mented liquors, which cannot be called a common drink among 
us. Whether I am well founded in this opinion or not, it is 
certain that in this section of the country, gout is comparative- 
ly a rare disease. I have, nevertheless, met with occasional 
cases of it, and they have generally happened in persons who 
had inherited a predisposition to it from their ancestors. Still, 
it has usually happened to the more luxurious, corpulent, and 
idle, without hereditary taint. 

The approach of gout may be seen in disorders of the diges- 
tive functions. The kidneys also are almost always evident- 
ly disordered in gouty persons. This has been attributed to 
the presence of the lithic acid in the blood, which I find is more 
and more regarded as the cause of gout. 

Few diseases have been more studied, or better described, 
than gout. It attacks persons usually in the prime of life. At 
the dead hour of night, the patient, who had previously ap- 
peared to be in the highest health, is aroused from sleep by the 
severest pain commonly in the joint of the great toe. This 
pain amounts to agony, and admits of no rest. The patient 
shifting from side to side, without being still for a single mo- 
ment, distinguishes this from an attack of rheumatism. Lan- 
guage has been tortured for terms to signify the agony which 



GOUT. 531 

attends this pain. The crush of a vise on the limb, turned till 
the pressure could be no longer borne, and turned again, has 
been thought to resemble the gout. A patient of mine describ- 
ed it by saying, that it resembled a rat tearing the flesh to pie- 
ces. This pain commonly lasts for about twenty-four hours, 
when relief spontaneously happens, almost as suddenly as the 
pain came on. The urine, which in the outset had been color- 
less, becomes now of a deep color depositing a copious sedi- 
ment. The joint affected becomes tumid, and the adjoining 
parts red and cedematous or dropsical in their appearance. The 
skin also in this case becomes red, forming another mark of 
distinction, between this disease and rheumatism. These 
paroxysms recur perhaps several days in succession, when 
they cease, leaving the patient with considerable swelling, and 
a tenderness which cannot be exceeded in any other disease. 
As the swelling subsides, the epidermis becomes detached, and 
peels off, leaving the joint exceedingly feeble, and often con- 
siderably altered in its appearance. After the first attack, the 
disease gives way, and the patient, freed from dyspeptic symp- 
toms by which he had been previously much affected, appears 
to enjoy for a time, much better health. He may now per- 
haps pass for years without another attack ; but if his luxuri- 
ous habits continue, if his potations of wine and beer are en- 
larged, he will hardly fail in due time to be reminded of these 
things by another attack of the gout. After this, the attacks 
become more frequent, and continue for a longer time. The 
pain perhaps may be less, but sickness and the prostration be- 
come greater. The joints become stiff from repeated attacks, 
and concretions around them, immediately next the skin, take 
place to a considerable extent. The matter forming these con- 
cretions has been termed chalk stones ; but it is in fact not 
composed of chalk, but of lithic acid variously compounded. 
With every attack these deposits seem to increase, until at last, 
in some cases, the hands or the feet become wholly deformed, 
and the skin gives way, exposing the bare chalk, as it has been 
termed. The nervous disorders at this stage of the gout, are 
peculiarly harrassing. The patient's mind is filled with the 
most frightful imaginations, and he is in all respects truly a 
pitiable object. 

Like rheumatism, gout is subject to be suddenly transferred 
from one organ to another. Sometimes from the foot to the 
hand, or rather from one foot to the other ; but in other cases, 
the transfer is far more alarming, falling on the stomach, and 
perhaps on the brain, causing, in many instances, sudden death. 



532 gout. 

I have said that gout is considered a hereditary disease. 
But no one can flatter himself that he might not become the 
subject of it, if he were to press forward in the use of the food 
and drink which produce it. The causes of gout seem to be, 
excess in eating, excess in drinking, and excess in idleness. 
Now as to which one of these causes may be most apt to pro- 
duce gout, it may not be easy to decide. My own opinion is, 
that it is caused principally by the use of fermented liquors, 
especially wine and beer. The habitual, and excessive use of 
these articles, it is thought, produces an acid state of the blood, 
generating in fact the morbific matter of gout. For it is be- 
lieved that the acid which is deposited around the joints of 
gouty persons, is in truth the cause of the disease. Parox- 
3 r sms of gout are often brought on by sudden emotion, or by an 
unusual amount of fatigue. 

TREATMENT. 

The treatment of gout may be divided into two stages — that 
which is proper in the paroxysm, and that which is proper in 
the interval. It was long the opinion of medical men, that the 
gouty patient was never so safe as when he had an attack of 
the disease, in one or another of his extremities. The late Dr. 
Barton, who had attacks of this disease, used to say in his lec- 
tures, that he was a happy arthritic, who had bis gout in his 
toe. This opinion has been the foundation of a great deal of 
error in the practice. Free living, and even excess, has been 
recommended. But this by the way, as we are now consider- 
ing the treatment of gout during the paroxysm. For a long 
time opiates and warm bathing were the principal remedies 
resorted to. But of late a remedy peculiarly powerful in these 
cases, has almost superseded every other. This remedy is 
colchicum or meadow saffron. It is considered by some a 
specific in gout. It is said to give ease, in the midst of the 
most frightful pain, to increase the flow of urine, and to change 
it from the acid state which is deemed the cause of the disease, 
to the alkaline, which is considered most compatible with 
health. From forty to sixty drops of the tincture or wine of 
colchicum, may be taken at bed time, and in the morning as 
long as the occasion for it may seem to be present. If the dis- 
ease continues, it may be used after a few days in less quan- 
tity. Mild purgatives find a proper place in the treatment 
here, and calomel, that great remedy for local disorders, should 
be used in moderation in combination with colchicum. 



gout. 533 

I have stated that paroxysms of gout are sometimes produc- 
ed by depressing emotions. They are sometimes relieved by 
emotions which are more violent and sudden. Doctor Rush 
mentions a case in which a gouty patient, who from having 
been alarmed by a wagon being suddenly run against the 
house, leaped from the chair to which he had been confined 
for months, and forgot the gout in his foot. I have known an- 
other case which may be compared to this. A gentleman hav- 
ing a foot extremely tender from gout, caused himself to be 
rolled in his arm chair to his piazza, to witness the robbery of 
a hive of bees. The hive, according to the prescription, was 
taken by a man and placed on his shoulders, while another 
was to set an empty hive in its place. The hive with the hon- 
ey was to be transferred to a convenient distance, while the 
bees were expected to leave it and take possession of the emp- 
ty one in its place. These industrious tenants had, however, 
very little notion of occupying the vacant hive. They sallied 
out and attacked the man who was bearing the hive on his 
shoulder, who instantly dropped k in the yard, and it burst- 
ed in man}-' places. The bees now desperate, attacked 
men, horses, and cattle, and soon cleared the yard of every 
living soul. But when the storm was over, inquiry was 
made for the gouty gentleman, and he was found at a more 
distant point than any other person in the company, hiddea 
securely in a gully in an old field. 

The treatment of gout during the interval between the at- 
tacks, is chiefly the observance of a proper regimen. If the 
patient is young, and in the prime of life, he risks nothing in 
total abstinence from spirituous or fermented liquors ; and this 
is for him the foundation of a proper treatment. A remedy 
from which he will at any rate experience great benefit, and 
probably entire relief from a dangerous disease. His food too 
should be that of a temperate man. I do not believe in the ne- 
cessity of making it poor and meagre. I believe an amount of 
nutritious food in due proportion to the exercise he takes, is as 
safe for the gouty as for any other individual. The great diffi- 
culty is to subdue the will of a gouty patient, so that he will 
pursue such a regimen. He views the attacks as distant, and 
indulges an appetite which is rather increased by the attacks 
he has had. The mind also should be carefully used with 
moderation. It has been said, and is probably true, that in- 
tense study is one of the causes to which gout is fairly attribu- 
table. Sydenham attributed some of his attacks, to the intense 
study which he did in the composition of his medical works- 



534 ABSCESS. 

The mind, like the body, may be too much imposed upon by 
intense application to its pursuits ; and this should be constant- 
ly present to the view of a gouty individual. As to exercise, it 
is not very likely to be carried too far. It should by all means 
be carried far enough to bring: with it the greatest degree of 
health and strength. 

We shall have done with the gout, after noticing the treat- 
ment proper for the disease when translated to internal organs. 
The stomach is the most frequent seat of these attacks, and 
awful indeed are the pain and danger which attend them. It 
is not, however, every pain in the stomach which a gouty man 
may feel, that is a real translation of that disease to this im- 
portant organ. Indigestion from an imprudent or excessive 
use of improper food, may cause an exceedingly severe pain 
in the stomach without much danger to the health of the pa- 
tient. The practitioner in this disease, will not hesitate to 
give an emetic to clear the stomach of its contents ; and man}' 
times he will find his patient entirely relieved. 

When the attack proves a real inflammation 01 the stomach 
from gout, it is to be treated as an inflammation of that organ 
occurring from any other cause, due regard being had to the 
debility which is manifestly present. As to inflammation of 
the brain, which may arise from this cause, it is generally so 
suddenly fatal, as to be scarcely a subject of medical treatment. 



ABSCESS. 

A collection of pus in any tissue or organ, is called an ab- 
scess. This matter is formed from the blood by a process 
which is unknown. In abscesses it is found encysted or en- 
closed, so that it can not escape into the adjoining parts. To 
this, however, there are exceptions, in which the matter formed 
in an abscess finds its way to distant parts of the body. Natu- 
ral cavities of the body, such as that which contains the lungs 
and the intestines, are sometimes, by the effect of inflamma- 
tion, filled to a considerable extent with pas. Nor does it ap- 
pear that any certain degree of inflammation, is necessary for 
the production of pus, for it is sometimes found to have been 
produced with but very slight symptoms of pain and tumor, 
which naturally belong to abscess. The pus which arises from 
acute inflammation, is pale, yellow, and turbid — that which 
arises from inflammation which has been long protracted, may 
differ very widely from this. I have seen it present the ap~ 



PLAGUE. 56b 

pearance of bloody water, and, in some cases, nearly trans- 
parent The curdy matter, which signifies the presence of 
scrofulous disease, is often seen floating in such matter. 

Few parts of the body are entirely exempt from the forma- 
tion of abscesses ; yet they are seldom or never seen in the sub- 
stance of muscular fibres, or in the cartilages which immedi- 
ately attach to the bones. The cellular membrane is the cho- 
sen seat of abscess. This tissue occupying all parts of the 
body containing generally fat, is the common seat ol this dis- 
ease. Abscess may also form in the substance of the lungs, in 
the liver, spleen, kidney, or even, though very rarely, in the 
pancreas. In the liver it is sometimes very formidable, pro- 
ducing as large collections of pus, as are met with in any part 
of the body. In these cases adhesion forms between this 
organ and the side, and the matter is frequently safely dis- 
charged by an external opening. In other cases, however, 
this adhesion does not take place, and the abscess being burst, 
discharges within the abdomen, producing certain death. The 
kidney and the bladder are also subject to form pus. These 
cases are uncommon ; but inflammation of these organs which 
results in this way is exceedingly dangerous. The urethra 
which extends from the bladder, may be a subject of this degree 
of inflammation, without any dangerous results. From this 
source, matter is frequently discharged without any dangerous 
symptoms ensuing. 

Various parts of the body besides those which have been 
enumerated, are subject to the formation of abscess. The dis- 
ease admits of no great variety of treatment. When a collec- 
tion of matter has happened, it should be discharged by an ex- 
ternal opening; but, during the progress of the inflammation, 
there are many cases in which it becomes proper to treat the 
case with considerable activity, to avoid, if possible, the for- 
mation of pus. This is especially the case where the liver or 
lungs, or other important viscera are concerned. Inflamma- 
tion in these organs tending to the formation of pus, should be 
treated with the mostactiveanti -phlogistic treatment, consisting 
in bleeding, cathartics, antimonials, and other kindred remedies. 



PLAGUE. 

The chosen seat of this disease is Egypt, and the other coun- 
tries surrounding the Mediterranean sea. For many years it 
has not been seen on that part of this coast which pertains to 



536 SCROFULA. 

Southern Europe ; but its visits there are not forgotten : the 
laws formed for its exclusion, are still in force in many places. 
They are, however, believed to be wholly unnecessary ; for 
the contagion of plague, if it ever was the cause of its intro- 
duction into the South and West of Europe, has ceased to pro- 
duce that effect, although the intercourse between these coun- 
tries was never greater than at present. It is doubted whether 
it is even a contagious disorder ; and many physicians who 
have tried the experiment, by attending sufferers under plague, 
have escaped unhurt. 

No disease is more entitled to the character of malignant, 
than this. It sometimes pervades whole districts of country, 
carrying off two thirds of all who are attacked by it. In other 
instances, it is comparatively a mild disease. 

Plague is a fever of the highest typhus grade, destroying 
life, in many instances, in a few days. When the case is pro- 
tracted a little longer, buboes and carbuncles appear, produc- 
ing extensive suppuration, which, many times, exhaust and de- 
stroy the patient, after a tedious suffering. 

The treatment most proper in plague has not been very de- 
fmately settled. As a grave and high typhus disease, we might 
reasonably expect the most benefit from the generous and sup- 
porting remedies. Fortunately, in this country, we are not 
very likely to become witnesses of its ravages. I shall, there- 
fore, dismiss the subject with these few remarks. 






KING'S EVIL— SCROFULA. 

A very large proportion of the diseases of the human family, 
are thought to arise from scrofula. By some, it is said to be 
the fruitful mother of a large number of the 4i seases °f tne 
skin, besides causing the formidable diseases, white swelling, 
consumption, and many others. To me, it appears exceed- 
ingly doubtful, whether the half of these diseases have a scrof- 
ulous origin ; but without attempting a discussion of these 
questions, I shall treat, under this head, only the diseases which 
are by all acknowledged to be scrofula ; and leave the affec- 
tions which have been known by other names, to be consider- 
ed under their proper denominations. 

Scrofula is considered a hereditary disease, arising from an 
inherent tendency in the constitution, derived from the father 
or mother, or both. This transmission of disease, is univer- 



SCROFULA. 537 

sally admitted in relation to scrofula ; and there have been 
many surprising examples of the disease having prevailed in 
parents whose children have escaped, and their grand children 
fallen victims to the fatal inheritance. It would then seem, 
that the disease arises naturally, in certain constitutional tem- 
peraments, and that the transmission from parents to children, 
is only a similarity of constitution, and not the seeds of dis- 
ease. 

The acknowledged tendency of scrofula, to appear in per- 
sons of a particular constitutional temperament, has led to 
much speculation as to what that temperament is. It is ac- 
knowledged that no temperament is entirely exempt ; and that 
all persons have more or less to fear from this fearful visitor. 
Those most subject to it, are of a pale or white complexion, 
with fine thin hair, slender limbs, fine skin, and great sensi- 
bility. Man}^ are characterized by high character, and high 
attainments. But many subjects of scrofula, are in all respects 
the reverse of this description ; having dark complexion, coarse 
hair, and sturdy limbs. Of late it has been said to be most 
frequent in those having a low order of intellect ; and that the 
negro is at least as subject to it as the white person. The in- 
ference from all this is, that scrofula is not a disease of any 
particular temperament or complexion, but that the tendency 
to the disease arises from causes not well understood. 

Although scrofula has been from an early day considered 
hereditar}', it has never been thought contagious. Many ex- 
periments have been made to test this question, and it is ac- 
knowledged, that the matter from scrofulous ulcers cannot be 
made to propagate the disease, in those unaffected by it. 
This is a very important fact, and I think may be relied on. 

Cold and moisture are regarded as the great cause of scrof- 
ula ; and it is certain that it prevails much more in countries 
that are cold and moist, than in others which are hot and dry. 
The poor who are exposed to hardship in populous places, 
where they are as crowded as they are destitute, are the great- 
est sufferers. Yet it is said, that in very high latitudes, where 
even the ice and snow of winter, are dry from extreme cold, 
that this disease is comparatively rare. England and Hol- 
land are said to be the countries in which there is most scrof- 
ula. 

Scrofula is a disease of the lymphatic glands, but often af- 
fects other parts of the body, producing disorders of various 
aspects and very difficult to judge of. The true scrofulous tu- 
mour, is found in the lymphatic glands of the groins, the arm- 



538 SCROFULA. 

pits, the angle of the jaws or the mesentery. The disease is 
by no means confined to these parts, but produces in them its 
most unequivocal symptoms. The progress of the disease is 
slow. At first a hardness and enlargement of the gland is felt, 
but with little pain, and no redness, or sensible increase of 
heat. In many cases this hardness and swelling of the glands, 
form the beginning and the end of the disease. I have often 
seen the swellings of these glands continue for years, and at 
last gradually subside, but never to their proper size. In other 
cases, the gland enlarges, and at last grows tender with some 
discoloration, but rather livid or purple than red. The sur- 
face assumes a smooth and shining hue, and on examination 
the fluctuation of matter, will be felt. On opening the tumour 
a thin glairy matter will flow, with occasional lumps, resem- 
bling curd. These lumps are considered proof of the nature 
of the disease. They are not easily described, and vary con- 
siderably in appearance. They are said to be formed early in 
the process of the enlargement, and to be at first somewhat 
solid, but not organised. As the disease progresses, they be- 
come soft, and are discharged in a state which has been com- 
pared to wet tow, wool, cheese, curd and I know not what 
else. They often close up the orifice made for their discharge, 
and give rise to a great deal of trouble. Large abscesses of this 
description are often met with, involving other organs besides 
the lymphatic glands ; but they are considered scrofulous. 
The worst of these abscesses, form in the joints. Those aris- 
ing in tubercular consumption, which is another form of scrof- 
ula, may be considered worst of all. 

But scrofula is, at the South, a less formidable disease, than 
it is in higher latitudes. The disgusting array of diseased 
glands, which deform the neck, and have, from the resemblance 
of the throat to that of a hog, given name to the disease, is 
rarely seen in this country. Nor does a slighter attack from 
the disease, foreshadow the train of incurable maladies, which 
follow it in other climates. I have witnessed many instances 
of scrofula in children, which have passed off, leaving the pa- 
tient free from disease, and in the enjoyment of tolerable health 
for the remainder of life. The cases of consumption which I 
have witnessed, have not oftener occurred in persons who have 
in childhood had scrofula, than in those who were free from 
that disease. The fatal cases of scrofula which it has occur- 
red to me to witness, have arisen from protracted glandular ab- 
scesses about the neck and groins, and abscesses of the joints in 
the form of white swelling. The various diseases of the skin 



SCROFULA. 539 

which have been thought to arise from scrofula, are, in my 
opinion, oftener the result of different diseases. 

It is difficult to limit the affections which might be treated of 
under the name of scrofula. The protracted diseases of the 
nose, eyes, ears, and lips, and the obscure diseases of the skin, 
which are so denominated because they are not better under- 
stood, I shall not pretend to understand better than my pre- 
decessors. 

I am persuaded, that no certain description can be given of 
the diseases which are entitled to be called scrofulous. I do 
not pretend to be able to say on the investigation of any case, 
that it is or is not scrofula. The curdy, or clabber-like mat- 
ter produced in scrofulous abscesses, is thought the unerring 
sign of the presence of the disease. But this curdy matter is 
only seen at a late stage of the disease ; and there are, un- 
questionably, many cases in which the formation of such mat- 
ter cannot take place in consequence of peculiar structure. 
What then are we to treat as scrofula ? 

The physician will often meet with diseases which are to 
be referred to this class. Many of them may deceive him, 
and pass off as common inflammation. But he is not to for- 
get scrofula. He will remember its slow approaches, always 
attended with the disorganization of some part. The neck 
w r ill present its enlarged glands, the tonsils their enlarged and 
inflamed appearance, the knees or ankles their enlarged and 
deformed appearance, and the skin its endless diseases. And 
shall I add that the lungs, by a rattling cough, a hundred times 
disappearing and re-appearing in childhood and youth, point 
out the existence of the same destroyer. The progress of all 
these disorders is slow. The parts enlarge, but do not change 
color ; and it is only when they have arisen to a great height 
of disease, that they become painful. They affect all parts of 
the system, the skin, the glands, the bones, the bowels, and 
the lungs are alike subject. We are then to treat as scrofu- 
lous diseases, those slow attacks which affect the parts with a 
low state of inflammation and gradual enlargement, produce 
fever with frequent and profuse perspiration, and tend to the 
formation of matter in the affected parts. These symptoms 
mav arise from affections of the bowels, or the lungs, the skin 
or the joints. From whatever organ the irritation springs, it 
produces a low, irregular fever, and this is the fever of scrofu- 
la for which I shall point out a method of treatment, 



540 SCROFULA. 

REMEDIES FOR SCROFULA. 

No remedy has been discovered which is entitled to any con- 
fidence for the removal of the cause of scrofula. The disease 
may get well, but not by the direct operation of remedies. If 
the patient can live, and the disease confine itself to a small 
compass, it at last gets well. White swelling gets well of it- 
self ; scrofulous glands heal at last, and the disease most of 
all dreaded, even a scrofulous consumption, sometimes gets 
well. It is very important, to lessen the irritation, limit the 
extension, and support the strength of those affected with 
scrofula. Many persons are born with a scrofulous tendency 
too strong, almost, to be resisted. Such persons are often pre- 
served by every effort to improve their strength and preserve 
their health. No particular direction need be given for such 
cases. They require every aid which may convert weak- 
ness into strength. But in spite of all, and sometimes in those 
who least expect it, the disease comes on. 

The first question which presents itself is, whether there is 
present a state of inflammation and fever, which will be bene- 
fitted by the use of depleting remedies. As a general rule, 
these remedies are improper in scrofula. They have been 
tried in a large field. The English bleed, and the French 
starve, for the relief of all inflammatory disorders. They have 
tried these remedies in this disease, and they have been dis- 
appointed. The inflammation produced by scrofula cannot be 
subdued by bleeding or leeches, antimonials or cathartics. 
The use of these remedies, in this disease, must be limited to 
the temporary abatement of pain and fever. They may post- 
pone suppuration to a later day, but they will not prevent it ; 
they may lessen fever, and pain, but they will not remove 
them. The rule is to use, and not abuse, depletion in scrofu- 
la. If the disease attacks the joints, the ankles, and wrists, 
for example, and is attended with much pain, leeches and cold 
applications should be applied to the parts. A cathartic may 
at the same time be given — rhubarb and magnesia in prefer- 
ence to any thing more active. These remedies may be fol- 
lowed by a dose of laudanum at night. How often they are 
to be repeated, and at what intervals, will depend on the ef- 
fect they produce, and the state of the patient. If they give 
relief from pain, and lessen fever, they may be repeated, but 
with due care not press them too far, as we have much more 
to fear from debility, than inflammation, in this disease. These 
remedies are, as I have said, of limited usefulness in scrofula. 



SCROFULA. 541 

They are to be abandoned, if the patient is much debilitated, 
and after the matter from abscesses is discharged. They are 
no longer useful, when the flabby ulcer, and thin skin over 
cavities hollowed out by suppuration, are present. 

Tonics are important remedies in scrofula. These include 
a wide range of exercise, diet, drinks, and remedies. Exer- 
cise in the open air is the great remedy for this disease. It 
should be suited to the age and strength of the patient, but is 
by no means to be neglected. Riding on horse back is con- 
sidered by far the best exercise for scrofulous diseases, and 
the exposure to rain, sun, and wind, which it gives rise to, are 
not considered as furnishing any objection to it. But other, 
and more convenient modes of exercise may be used. Walk- 
ing is a good mode of giving exercise to the body ; but the 
muscles of the body and arms are not sufficiently brought into 
use, unless the speed is raised to running. This is according- 
ly advised, and is preferable to the throwing of weights or 
other contrivances to bring particular muscles into violent ac- 
tion. Whatever mode of exercise is chosen, it should be pur- 
sued with due diligence. If riding, let it be on a hard trotting 
horse, pushed as long as the rider can well bear it. If exer- 
cise on foot is chosen, let running, especially up hill, be a part 
of the direction. If labor of any kind is preferred, let it be 
like the man with the baton in the Persian Tales, pushed so 
far as to cover the body of the patient with perspiration. This 
means of giving strength and power to the body, can hardly 
be over estimated. It will not do, even in childhood, to trust 
this great want of nature to the calls of inclination. Scrofu- 
lous patients are inclined to be torpid, and will not, except 
under positive injunction, take sufficient exercise. Still it is to 
them the most important of all remedies, and is to be insisted 
on as the foundation of proper treatment. If exercise in the 
open air is taken, it can hardly be carried too far or continued 
too long, if the fatigue can be borne. It is surprising to see 
what amount of severe exercise even the consumptive can 
take, with advantage. 

The pure stimulants, and mineral and vegetable tonics, find 
their place, in the treatment of scrofula, at an earlier day than 
might be expected. The disease is one of debility ; and if 
there is fever present at some part of the day, there is still a 
longer portion, in which the pulse is low, and the skin moist. 
During this time, some tonic or stimulant should be taken. 
Trial may be made of fermented liquors — porter, strong beer, 
or wine. Observation and experience of their effects must 



542 SCROFULA. 

govern their administration in each case. Proof spirit may al- 
so be tried, and I have found good brandy a first rate remedy 
in these cases. It may be given in the shape of toddy, or bran- 
dy and water, three or four times a day ; alwa}^s choosing the 
time in which the skin is moist for its exhibition. I have more 
faith in these pure stimulants, than I have in the bitters and 
mineral tonics which I think are commonly preferred. A skin 
flowing with perspiration belongs to scrofula, in whatever form 
it is met with. I have advised pure stimulants to combat 
these symptoms; but others prefer the mineral and vegetable 
tonics. There is no decided preference due to any particular 
article of these classes. The elixir of vitriol may be given in 
doses of from ten to twenty drops, two or three times a day — 
or the muriated tincture of iron, in doses often or fifteen drops, 
twice a day — or the compound tincture of gentian, in doses of 
a tea spoonful twice a day. The wild cherry furnishes a bit- 
ter which is thought to carry with it a peculiar anodyne influ- 
ence, beneficial in cases of scrofula. A tincture from its bark, 
or a decoction made by pouring boiling water on it, may be 
tried. These preparations should be made strong, by using 
the bark in excess. Of the tincture made by steeping the bark 
in proof spirit, a tea spoonful or two may be taken at a dose ; 
the decoction made by boiling the bark a few minutes in water, 
may be taken in doses of one or two table spoonsful. 

All these remedies for the restoration of the health of scrofu- 
lous patients, are to be used with diligence and perseverance. 
They are not to be persisted in too long, when they are not 
found to be beneficial, but may be changed or extended to 
other remedies ; taking care to use them one at a time. Let 
the treatment always rest on some particular remedy, and 
change it when it is not found to answer. The old plan of 
using a multitude of remedies, under the vain hope, that some 
antidote to the disease might thus be included in the prescrip- 
tion, can never be sufficiently repudiated. 

Scrofula is a disease of the constitution, and the remedies I 
have mentioned do not pretend to the removal of the constitu- 
tional tendency. But if they preserve a high degree of health, 
or restore the lost strength of the patient, the scrofula may be 
kept from advancing perhaps for a whole life. There can be 
no doubt, that many persons who have a constitutional tenden- 
cy to this disease, escape it when thrown into a favorable cli- 
mate, and under circumstances calculated to ensure health. 

But physicians have not willingly submitted to a plan of 
treatment so restricted in its purposes. Remedies termed al- 



SCROFULA. 543 

teratives, have been used with more or less confidence in 
scrofula, for a great length of time. These remedies are sup- 
posed to have power to remove the cause of the disease, and 
hinder the liability to its return. This high pretension has not 
been ratified by time and experience ; but there are several 
medicines which I think entitled to some confidence, for their 
peculiar effects, and for which I know no better name than al- 
teratives. Of these, I shall mention only two — mercury and 
iodyne. Mercury is thought to stand on equivocal ground, in 
the treatment of this disease. It is even thought by some, to 
produce of itself a disease much resembling scrofula, and ma- 
ny are the deaths which have been attributed to its indiscreet 
use. I think it only necessary to say in this place, that I think 
this is a prejudice without any just foundation. No patient 
should be allowed to run into a wasting hectic fever, from 
scrofula, without a fair trial of mercury. We are charged 
against pushing the remedy to high salivation, in these cases. 
My experience is, that there is very little danger of this. Pa- 
tients, in scrofula, waste at every pore. Their bowels are 
easily excited by cathartics, their lungs throw off mucus in 
abundance ; and the skin and the nostrils and the eyes, throw 
off their accustomed secretions, with great excess. Such pa- 
tients are not easily salivated. On the contrary, I have found 
it exceedingly difficult to produce on them the slightest mer- 
curial impression. I have found the bowels, in such cases, 
incapable of retaining a single grain of calomel ; and the reme- 
dy, in any form, wholly inoperative, except as a cathartic. I 
advise a trial of mercury, in all cases of scrofula, where the 
constitutional symptoms are serious, and hectic fever is begin- 
ning its career. If there is extensive ulceration of the skin, 
large swellings of the glands, or abscesses involving the joints 
or deep seated organs of the body, give this remedy a fair trial. 
Take of calomel ten grains, opium five grains, and divide into 
ten pills ; of which, give one, evening and morning. If on 
using the whole, no symptom of salivation appears, prepare 
ten more pills, and continue them in the same way. Con- 
tinue this remedy in this way till a slight salivation is brought 
on, or till it is found impracticable to effect it. When a slight 
swelling of the gums is brought on, and some spitting, with 
the fetid breath, so easily known as an effect of salivation, the 
remedy is to be suspended for a few days. If the salivation 
grows less, the pills may be taken, one a day, so as to keep 
the mouth a little sore, but not so much as to hinder the chew- 
ing of bread. If the patient is a child under seven years old, 



544 SCROFULA. 

* 4 

a salivation is to be avoided, or kept within narrow bounds. 
Children ought not to run the risk of a salivation, without ne- 
cessity. But the remedy may be used safely at any age ; and, 
in children, is only to be more carefully watched, and suspend- 
ed, if salivation takes place. If the symptoms grow no better 
from salivation, the remedy is to be abandoned, after a week 
or two. Other preparations of mercury are sometimes pref- 
erable to calomel. The corrosive sublimate, or bichloride of 
mercury, is preferable where the disease is attended with 
much suppuration, or attacks the skin. Take ten grains of 
corrosive sublimate, and dissolve in an ounce of proof spirit, 
and give ten drops, two or three times a day. If it produces 
vomiting, lessen the dose ; and if it produces salivation, sus- 
pend it, and proceed as if the salivation had been brought on 
by any other means. 

The hydriodate of potash, a tripple compound of mercury, 
iodine, and potash, is said to unite the properties of these reme- 
dies, in an eminent degree ; and is probably at the present 
time, more extensively used as a remedy for scrofula, than 
any thing else. Take of hydriodate of potash one drachm, 
dissolve in two ounces of water, and give from forty drops to 
a tea spoonful, evening and morning. If it produces pain 
about the throat, sneezing, or other painful irritation, the dose 
may be lessened. This remedy will seldom produce saliva- 
tion, swellings of the face, or other unpleasant irritation; but 
it is to be used with due care, not continued more than two or 
three weeks at a time, and suspended if it produces much con- 
stitutional disorder. 

. In the treatment of scrofula, it is to be recollected, that the 
disease is chronic and constitutional ; and that, in some of its 
forms, it may be present without proving fatal, for an ordinary 
life time. Slight attacks of it are, therefore, not to be unne- 
cessarily interfered with. The disease should be carefully 
watched ; and if found to be increasing, the proper remedies 
administered for its relief. If it grows worse after a sufficient 
trial of one remedy, let another be prescribed ; for I know of, 
no rule by which the physician can be certain before he has 
made the trial, what remedy will prove most beneficial in a 
particular case of scrofula. 

The treatment of the local disorders which arise in scrofula, 
must be regulated by the circumstances which attend the case. 
Where the disorder attacks the bones or the joints, producing 
deep-seated and extensive swellings, the local remedies are to 
correspond with the violence of the attack. If the swelling has 



SCROFULA. 545 

I ' 

been sudden, and the pain intense, leeches, cupping, or cold 
applications, may for a time be tried. But it is a great deal 
more common for these swellings to make their advances more 
slowly, and to produce their effects without a great deal of 
pain. When these swellings take place in the glands, they are 
quite as indolent and free from pain, as in many other situa- 
tions. Such indolent tumours are to be treated with stimu- 
lants, rather than other remedies. Heat and moisture may be 
applied by means of hot poultices, renewed several times a 
day. Tincture of iodine may be applied over the swelling, by 
means of a feather, once or twice a week. It should be so ap- 
plied as to color the skin deeply, and then allowed to evapo- 
rate to dryness. It will produce a sense of warmth and pain 
in the part, but will not cause blistering, unless the application 
has been continued too long. Should it produce blistering, no 
application will be necessary on account of it ; the blister will 
heal very soon, and the remedy may again be applied, if ne- 
cessary. Other stimulants may be applied, in these cases, 
with advantage. 

Ulcers which arise from scrofula are slow in the process of 
healing. The glands of the neck and arm-pits, are often dis- 
charging their pale, thin, and frequently curdy matter, for ma- 
ny weeks before they can be made to heal. The affections of 
the skin which arise from this cause, are equally untractable, 
and much more difficult to be known. Many ulcers are im- 
properly charged to scrofula, by experienced physicians ; and 
it is not to be expected, that others should escape such errors. 
But such mistakes are not often productive of much injury. 
The worst consequence is the neglect they sometimes occa- 
sion in cancerous ulcers, which require extirpation by the sur- 
geon's knife. 

Open scrofulous ulcers are to be treated with stimulants and 
styptics. Alcohol, tincture of myrrh, tincture of bark, proof 
spirit, or other remedies of like properties, may be applied, 
once in a day or two. The strength of the application may be 
regulated by the addition of water w r hich is to be added till 
the remedy does not produce too much pain. But such ulcers 
are commonly insensible, and may be treated with undiluted 
tincture of myrrh or alcohol. Where the ulcer is deep, lint 
may be inserted, and tincture of myrrh dropped on it. The 
lint should be renewed, from day to day, and not packed or 
forced in, but laid gently on, or inserted in such a way as to 
produce the least pressure. A plaster of simple ointment may 
be applied over the lint. 
35 



546 SCROFULA. 

Styptic applications destroy unsound or unhealthy granula- 
tions, and give an opportunity ibr those which are healthy to 
rise in their stead. The best styptic is lunar caustic. The 
part may be touched with the solid caustic, or a strong solu- 
tion applied with a small mop, or comel-hair pencil. Forty 
grains of caustic, dissolved in an ounce of water, is not too 
strong. The application of a few drops at a time, will be suf- 
ficient. Arsenic, in the form of Fowlers solution, may be 
applied in the same way : and when there appears to be no 
benefit, in the application of lunar caustic, should be tried. It 
will be safe to apply it with a pencil, to a raw surface for a 
few days ; but it is not to be forgotten, that arsenic is a poi- 
son which may be absorbed from a raw surface, and on that 
account is not to be used longer than it is found necessar} T . A 
solution of corrosive sublimate, in water or spirit, maybe used, 
under the same restrictions. Four grains of corrosive subli- 
mate, in an ounce of proof spirit, may be used. Ten grains of 
corrosive sublimate, dissolved in an ounce of lime water, forms 
a wash, which has been much used in ulcers of this descrip- 
tion. The red precipitate is another preparation of mercury, 
which I have found extremely useful in indolent ulcers, wheth- 
er scrofulous or not. It may be applied by sprinkling it on 
the raw surface, or it may be rubbed into lard, or simple oint- 
ment, in about the proportion of a drachm of red precipitate 
to an ounce of simple ointment. If the surface affected is ex- 
tensive, this remedy may be absorbed, and produce salivation. 
I have used it on ulcers of the legs, not only as a styptic, but 
with a view to produce salivation ; and have found it a safe 
and successful remedy, for both purposes. 

I have not mentioned, the remedies, which once had most 
faith and confidence attached to them, as cures for scrofula, 
It was once thought, that if a true saint, or a true king, laid 
hands on a child affected with scrofula, the disease would dis- 
appear. The common name king's evil, has grown out of this 
superstition. For ages it was the custom of the kings of Eu- 
rope, to give audience to, and touch those afflicted with this 
disease. The shrines of saints were visited by multitudes for 
the same purpose. The testimonials of relief from rites so 
puerile, are so strong that it has raised a question, whether 
there may not be some relief from remedies affecting the ima- 
gination alone. Reasoning from analogy, there would appear 
to be as little hope from remedies of this description, in scrofu- 
la, as in an}' other disease. A fair trial of them is extremely 
difficult ; for the effect produced can only correspond with the 



CANCER. 547 



superstitution of the patient. I believe the cures pretended to 
have been performed, have been the manufacture of credulity 
and exaggeration ; and that the contempt now entertained for 
these workers of miracles, is no more than they were always 
fully entitled to. 



CANCER— CARCINOMA. 

Cancer is fortunately not a very common disease ; yet it is 
so common, as to be an object of reasonable fear to mankind. 
Jts untractable, or rather incurable nature, is universally con- 
ceded. It has not been till within a few years, that anything 
like a scientific knowledge of this subject has been obtained. 
And even yet it is quite uncertain, whether we are not treating 
of several distinct diseases under this single title. This, how- 
ever, is a matter of less concern, since all those of which we 
are now to speak, are equally incurable. 

The first and most common form of cancer, is what has been 
termed scirrhus. This is a growth as hard as cartilage, tak- 
ing up its residence, as it were, in some of the softer tissues of 
the body — in the lip, the tongue, the breast, or other part. 
The part attacked by it, becomes totally altered in its struc- 
ture ; that which was soft, becomes hard — so hard, that cut 
through with a knife, a creaking noise is heard ; it is even har- 
der than an ordinary tendon. Bands of this structure are 
found to cross the tumour in various directions. These bands 
are considered the distinctive characteristic of scirrhus or 
cancer. 

The next variety of this disease has been called the ence- 
phaloid, or brain-like. It is first noticed in the form of a soft 
tumour, commonly seated next to the bone. It is exceedingly 
elastic to the touch, more so perhaps than flesh becomes under 
any other disease. It is not attended in the first instance, with 
much pain, but like other cancerous diseases, becomes ex- 
ceedingly painful in its course. Every part in contact with 
this tumour, seems to perish. The bone, as I have repeatedly 
observed, becomes carious and brittle ; after having amputa- 
ted a leg affected with this disease, I have found the bone so 
brittle, that I was enabled to break it in my hands. The tu- 
mour at last bursts, forming an exceedingly offensive fungous 
mass, bleeding at the slightest touch ; and many times without 
being touched at all, the blood bursts forth and flows in great 



548 CANCER 

quantity. The disease has in such cases, been termed bloody 
fungus. 

A third variety of cancer has obtained the name colloid or 
gummy. It exhibits when divided, cells filled with a tena- 
cious matter resembling gum. It is less frequent I think, than 
other varieties, for it has never fallen under my notice. It is 
however equally destructive with the rest. And the individu- 
al, who is so unfortunate, as to become the subject of either of 
these diseases, has no chance to escape with life, except by 
the amputation of the limb or part on which it originates. And 
even when its excision, or amputation is performed at an early 
day, it is too common to see the disease returning again near 
the same, or on some other part of the body. 

It may well be questioned, whether these formidable disea- 
ses should be classed together. They have in common a sin- 
gle feature, and that is, their destructive tendency. In other 
respects, their course is very different. But they are classed 
together from another reason which, if time shall verify, justi- 
fies us in considering them the same disease. When the dis- 
ease, in one of its forms is extirpated, it is said that it frequent- 
ly re-appears in one of the other forms. For instance, when a 
scirrhus breast is amputated, the encephaloid, or brain-like tu- 
mour may follow. Of this, however, I have not seen an in- 
stance. 

All parts of the body are subject to the attacks of this dis- 
ease ; yet they are not equally subject. In the scirrhus form, 
I believe it is more common in the breast, about the lips, or 
tongue, and in the organs of generation. The brain-like va- 
riety usually takes its rise in parts deeper seated — near the 
bones. I have seen it originate on the bone of the arm, leg, 
hip, and in one instance, on the spine. Females are more sub- 
ject to it than males, and it is more likely to occur in aged, 
than in young persons. 

The cause of this disease is involved in impenetrable obscu- 
rity. The strange manner in which it converts parts of the 
body into a new and peculiar growth, has led to the supposi- 
tion, that it might be of a parasitic character, and induced from 
without the body. No means however of avoiding or escaping 
such a thing, have been suggested, nor have we any good rea- 
son for supposing the disease infectious. Surgeons have hand- 
led such tumours in safety, time out of mind. 

TREATMENT- 

We need not dwell long on the treatment of cancer. A sin- 



CANCER. 549 

gle dispute rests over the question, ought these tumours on their 
first appearance, to be extirpated by the surgeon ? Such a 
question would not have been raised without a very great num- 
ber ot* failures of success from the excision. The experience 
which I have had, must be considered exceedingly small when 
compared with the reports from the great number of such ca- 
ses presented in hospital practice. It is, therefore, with great 
doubt and misgiving, I would offer an opinion of my own on 
this question. And I premise this opinion with the statement, 
that the practice of letting such tumours alone, seems to be 
gaining ground. The danger of a relapse, or rather what is 
now considered almost the certainty of a relapse, has deterred 
surgeons from performing these operations. Still I must state, 
that from my own experience, I should decide in favor of per- 
forming this operation, whenever it can be perfectly accom- 
plished. I have not found it return so often as one would be 
led to expect from the accounts we read. I could now point 
to numerous cases where I have performed the operation ; in 
one where the breast of a female has been removed, now for 
thirty years, and she still lives in health. Several others I 
might mention of later date. Now in these cases, it is true the 
tumour might not have been cancerous ; it had proved incura- 
ble, and as I thought, after excision was cancerous, but in this, 
I might have been deceived. It is a serious thing to abandon 
to certain death, a patient with a disease of this description. 
In many instances, the amputation is justified even for the tem- 
porary relief it offers. I have now under my direction a fe- 
male, who from a disease of this kind in the breast, was redu- 
ced to the last extremity. A year ago, I performed the ope- 
ration of excision, apprising her at the same time, that the dis- 
ease would probably return. In six weeks after the operation, 
she was in a high state of health, and so remains at the present 
time, having for this year, escaped the torture of being destroy- 
ed by cancer. Yet it is right to state, that there are manifes- 
tations of a return of the disease near the seat it formerly oc- 
cupied. Now this operation, although it may be called unsuc- 
cessful, was certainly worth performing. 

As to the local applications which may be made to these dis- 
eases, they are such as may best promote the comfort of the 
patient. The caustic stimulants and other painful remedies 
which are too often applied, are mere cruelty. If the excision 
of the partis important, let it be done with a knife which will 
not give perhaps a hundreth part of the pain which the de- 
struction of the same parts by caustics would give. When the 



550 EATING CANCER. 

disease has approached its termination, and assumed its most 
hideous form, producing a torture indescribable which it is so 
apt to do, I have but one remedy to mention, and that is opium, 
Give it in the form of laudanum, morphine, or in pills of solid 
opium. These form, in my opinion, the only comfort left to 
persons in this unfortunate condition. 



EATING CANCER— LUPUS. 

This disease has been a subject of dispute between medi- 
cal men, from an early period. The question is, whether lu- 
pus, or eating cancer, as it is termed, is a distinct disease from 
carcinoma or true cancer ; or whether it is the same disease 
assuming a different form. Most medical writers of this day, 
are of the opinion, that they are distinct diseases, and as such, 
we shall treat them. 

Eating cancer can hardly be said to have an English name. 
The Latin name noli me tangere or touch me not, is no longer 
regarded as proper, for the idea, that any interference with the 
disease would prove injurious, is no longer entertained. The 
word lupus which signifies a wolf, is thought most descriptive 
of the ravenous or devouring character of the disease. The 
term eating cancer, I take from common parlance, and believe 
it will be generally understood. Between lupus and cancer, 
there is a very great resemblance. In the last stages,, they be- 
come equally untractable; but while cancer is a disease of the 
whole system, and curable alone by general remedies, the lu- 
pus or eating cancer, of which we are speaking, is not only cu- 
rable, but very often cured. And what is perhaps of most 
consequence, is that the cures are not effected by medicines 
administered internally, but by operations and local remedies. 
It is true that in the last stage of the disease, when it has pene- 
trated too deeply to be removed by the knife of the surgeon, 
there is yet a hope of relief from general remedies, but this 
does not prove that the disease in the outset was a constitu- 
tional malady. 

Eating cancer almost always makes its appearance on the 
face, most commonly on the nose or eyelids ; although any part 
of the face is subject to its ravages. I have seen several cases 
of it on the mouth ; the worst I ever witnessed, was where it 
made its appearance on the lower lip, extending down to the 
chin and involving the neck. This patient was a man of prop- 



EATING CANCER. 551 

erty, and had every necessary attention ; and had the diseas- 
ed mass removed by a surgical operation ; but without suc- 
cess. 

Authors say, that this is a disease of youth, appearing most 
commonly from the age of six to sixteen ; and that it is rarely 
known to appear in a man of forty ; but my own experience is, 
that it appears later in life. 

Lupus first makes its appearance as a small tubercle, in the 
tissue of the true skin, or immediately under it ; and sometimes 
in the mucous membranes of the mouth or nostrils. It gives 
no pain at first, but gradually rises in the skin, causing a vio- 
let, or dark color on the external surface. It continues to in- 
crease in size ; at first very slowly — so slow, that it is scarcely 
perceptible to the patient ; but as the disease advances, it as- 
sumes a more rapid progress, and sometimes terminates fatal- 
ly in a few months. Generally speaking, a man suffering with 
lupus, will live several years, even in its progressing state. 
A man may have lupus and live a life time, and never suffer 
much injury from the disease. Sometimes even after it has 
progressed to a considerable extent, it has suddenly ceased, 
and the patient has recovered without ever having a return of 
the disease. 

In its progress, lupus is exceedingly variable, sometimes 
producing only a slight dry scab, commonly on the side of the 
nose, and remaining for many years with scarcely any increase 
in its size or depth. In other instances, it produces a tumour, 
or as it has been termed tubercle, on the surface of which there 
lorms a scab, which is after a time detached, leaving a raw, 
and sometimes bleeding surface. These scabs are renewed, 
from time to time, and always seem, when removed, to leave 
the ulcer larger than it was before. In this form, the disease 
is apt to attack the nose, and sometimes the tubercle is formed 
within the nostril. From whatever part it proceeds, its pro- 
gress is destructive, destroying in its course, the skin and deep- 
er seated parts. At length, as if tired of the slow progress 
made, in destroying thin layers or scabs, deep ulcers are form- 
ed from which portions of putrefying flesh are thrown off*, leav- 
ing the most wide spread and frightful ulcerations, which can 
be conceived of. After a great deal of annoyance, but rarely 
of very acute pain, the patient's health gives way, and, under 
a slow process of hectic fever and wasting disease, he expires. 
The catastrophe is sometimes hastened, when the disease pene- 
trates the trunks of some of the large arteries of the neck, 
producing hemonhage and sudden death. 



552 EATING CANCER. 

In a few rare cases, this disease presents itself in flat soft tu- 
bercles, growing to some size under the skin, before they 
break into ulcers. The sanious fluid which collects, forms 
closely adhering scabs, which seem to promote an extension 
of the ulceration. These ulcers frequently heal, producing 
great reputation for whatever remedy may have been used ; 
but they are liable to return, especially in persons who are lia- 
ble to excesses, either in eating or drinking. 

Lupus is said to be more common in females, than in males ; 
it is more likely to occur in those of a Lymphatic temperament, 
in which the menstrual function is feebly performed. It is 
said to be more common in the country, than in towns ; and 
also more common among the laboring and poorer classes, 
than others. 

TREATMENT. 

The treatment of eating cancer may be divided into that 
which is local, and that which is general. It is true, the dis- 
ease is most commonly entirely local, at the* time of its com- 
mencement ; but, as the case advances, the constitution be- 
comes so much involved, that no treatment could be consider- 
ed sufficient, without due regard being had to the general 
health of the patient. It is, moreover, thought, that scrofula 
is a very frequent cause of this disease ; and, in a case so diffi- 
cult to manage, this forms an additional reason for not over- 
looking the use of general remedies. 

The first internal remedy which I shall mention, is iodine. 
Take of iodine twenty grains, dissolve in one ounce of alcohol. 
To a grown person, give twenty drops, twice a day. If the 
dose produces sneezing, or unpleasant sensations about the 
throat, or trembling, or giddiness, a less quantity may be given ; 
but the experiment should not be abandoned till at least one 
ounce vial, such as I have described, has been used. The 
hydriodate of potash is another preparation of this remedy, 
which has been much extalled in these cases. Take of hy- 
driodate of potash, one drachm, dissolve in a vial with two 
ounces of water, and give twenty drops, twice a day. Either 
of these remedies, may be tried separately, in such doses as 
the patient may be found to bear with convenience ; and they 
should not be abandoned, till by a trial of several weeks, they 
are found to be ineffectual. Preparations of mercury have, in 
some cases, proved very beneficial. Corrosive sublimate is 
probably the most to be relied on, in these cases. Take of 
corrosive sublimate ten grains, dissolve it in one ounce of proof 






EATING CANCER. 553 

spirit, or diluted alcohol. Give ten drops of this solution in 
water, twice a day. This remedy is to be persisted in for 
several weeks. If it produces nausea or pain in the stomach, 
the dose should be lessened. If symptoms of salivation ap- 
pear, and the disease does not give way, this remedy should 
be abandoned. Arsenic has been found beneficial, in many 
cases. The most agreeable, and I will add, beneficial prepa- 
ration of this remedy, is the arseniate of potash, or Fowler's 
solution. Of this remedy, give ten drops, three times a day. 
If it produces pain or sickness at the stomach, lessen the dose ; 
but continue the remedy for two or three weeks, recollecting 
that it is to be laid aside if it produces dropsical swellings, 
paralysis, or other alarming symptoms. All these are reme- 
dies of a high degree of power over the constitution ; they are 
recommended in doses, and under regulations, which are en- 
tirely safe. No certain rule can be assigned for a preference 
for one of these remedies over another, in any particular case. 
If one fails, another may succeed ; and they should be tried 
alternately, without too much precipitation or haste. 

Where patients become exhausted, and show symptoms of 
declining under the effects of this disease, remedies of a pure- 
ly tonic and stimulating kind, become necessary. The prepa- 
rations of iron, hold the first place amongst these remedies. 
Take of carbonate of iron two drachms, mix in mucilage of 
gum Arabic, or any other convenient vehicle, and form twen- 
ty-four pills ; give from two to three of these pills each day. 
Other preparations of iron may be given, with equal advan- 
tage. Probably the muriated tincture is the best of these ; 
from five to ten drops, in water, may be given, three times a 
day. Vegetable tonics are also proper. • The compound tinc- 
ture of gentian, in doses of a tea spoonful, twice a day ; or 
other bitter vegetable remedies in common use, may be tried. 

It is to be recollected, that the disease of which we are 
speaking, is exceedingly tedious ; and that there are but few 
cases in which it threatens the immediate destruction of life. 
It is, therefore, proper to use all remedies employed in it, with 
great deliberation and care. 

External remedies are allowed to be of more use, than in- 
ternal, in lupus. Arsenic is probably the best of these. This 
powerful mineral, has been found in the most celebrated can- 
cer ointments, and plasters, which have been vended by 
quackery from an early day. Sir Astley Cooper's ointment, 
composed of one drachm of white arsenic, one drachm of sul- 
phur, and an ounce of simple ointment, rubbed well together, 



554 EATING CANCER. 

may be applied in the form of a plaster, where the position of 
the ulcer admits of it. This plaster will be a painful applica- 
tion, but should be continued till a change in the surface it is 
applied to, is seen, and some considerable irritation produced. 
I do not advise the continuance of this remedy, till a great mass 
of flesh is destroyed. If the disease gives way to the remedy, 
it will be seen without proceeding so far with it ; and it is to 
be recollected, that arsenic when externally applied, sometimes 
affects the system, as if it were taken internally. If the plas- 
ter produces great pain, it may be removed in a few hours, 
and one of simple ointment applied ; but if, from the state of 
the surface at the time of the application, no great pain is felt, 
it may be worn a day, and then repeated, if necessary. When 
from the great loss of substance, it becomes desirable to save 
the parts as much as possible, a milder application of arsenic 
may be made. The remedy may be applied in solution, in 
the Fowler's solution, which has been spoken of, by wetting 
the raw surface with it, by means of a feather. Arsenic should 
be applied on the raw surface alone, and not in the form of 
powder, because its action cannot be properly regulated in 
that mode of application. Of the numerous other styptic reme- 
dies, which have been recommended in this disease, I prefer 
the preparations of copper. The carbonate of copper, or com- 
mon verdigris, rubbed in cream, and daily applied with a 
feather, has, in my hands, seemed to effect a cure. A strong- 
solution of sulphate of copper or blue stone, in water, is also a 
valuable remedy. Ten grains of the remedy maybe dissolved 
in an ounce of water. A sudden and powerful impression, 
may be made by touching the raw surface with a solution of 
creasote in alcohol, in the proportions of a drachm of creasote 
in an ounce of alcohol ; or with twenty grains oflunar caustic, 
dissolved in an ounce of water. These remedies may be ap- 
plied with a feather or small mop, they have the advantage 
of producing only temporary pain, and not being followed by 
inflammation. 

The remedies recommended for lupus, are chosen in refer- 
ence to the absence of inflammation and fever, which common- 
ly attend the disease. But there are many cases, in which 
the disease is attended with considerable pain, and more or 
less fever. In such cases, leeches should be applied to the part, 
or a mild laxative given, and a low regimen recommended, 
for a time. Plasters of simple ointment may be applied to the 
ulcers, and the case in all respects treated as a moderately in- 
flamed sore. 



mumps. 555 

It is not easy to say, when there is no hope of amendment 
in lupus ; for the disease proceeds rapidly for a time, and then 
ceases, and gets well ; or more frequently goes on to the end, 
in its destructive course. The general health of the patient 
should be carefully watched, and remedies applied where they 
may be necessary. There are many cases which are suspect- 
ed of being connected with a scrofulous habit ; but I think such 
cases are by no means common, at the South. 

Few cases of eating cancer are treated with remedies too 
mild. On the contrary, caustic solutions and stimulating oint- 
ments are used in quick succession, producing great aggrava- 
tion of the pain, and rapid loss of substance. Such cases 
should have a fair trial of a milder course. The daily appli- 
cation of fine lint, wet with a weak solution of sugar of lead, 
or of water alone, should be tried. When the surface admits 
of it, a plaster of simple ointment may be tried. And, in every 
case, let it be borne in mind, that the caustic remedies hinder 
the process of healing, and should not be used too often, or in 
too quick succession, one after another. 



MUMPS— CYNANCHE PAROTIDEA. 

The disease, known in this country by the name of Mumps, 
is known by a swelling of the glands at the angle of the jaws, 
attended with some pain and fever. It is a contagious disease, 
and affects the same person, but once during life. The dis- 
ease is attended with but little danger, but is in some respects 
interesting. 

There is nothing in the symptoms of mumps, which will at 
first, enable us to distinguish it from an attack of common in- 
flammation. But this is not a matter of much consequence, as 
the disease is commonly mild, and will not be the worse for 
the use of any mild remedy for inflammation. The attack of 
mumps is attended, with more or less fever. The patient com- 
plains, of some pain at the angle of the jaw, which will be in- 
creased in pressing the teeth together, and on examination con- 
siderable swelling will be seen immediately below the ears 
and extending across the throat. Sometimes the swelling at- 
tacks one side only, and ceases without extending any farther. 
The swelling and fever continue to increase for three or four 
days, after which they gradually subside, so that in eight or 
ten days the patient is usually well. This is the natural and 



556 mumps. 

usual course of mumps, and the disease is so mild that no 
remedy is required in its treatment. 

But mumps is not always, so mild a disease as. we have 
represented it ; and there are some peculiarities in it, which 
are curious and instructive. The first of these peculiarities 
which we shall notice, is that although it affects persons but 
once in their lives, an attack affecting one side of the throat 
only, does not protect the other side from a future attack. The 
fever which attends the first attack, does not hinder a fever 
with the second. It seems therefore that the disease consists 
in a peculiar inflammation of the salivary glands, and that these 
glands, must each, have it for itself. The next peculiarity of 
mumps is, that the inflammation sometimes recedes and is 
transferred to other glands — to the breast in females, and to the 
testicles in males.. This inflammation, when it occurs in the 
breast, seems to be attended with relief to the throat and jaws, 
and passes off without doing any injury to the breast. But it 
is thought to be less favorable in the testicles, for these organs 
do not always escape permanent injury. I say, not always, be- 
cause I read that the testicle is in some cases, enfeebled, and 
in others that it is absorbed and totally disappears after being 
inflamed and swelled from mumps. Now these accidents are 
so rare, that they have never occurred under my observation. 
I am therefore in the habit of telling my patients who are suf- 
fering in this wa}', that they have nothing to fear in the way of 
final injury to these organs. These swellings of the breasts, 
and testicles, never occur in young children, but only in those 
who are of an age for these organs to have commenced the 
growth and development of puberty. I am unable to assign 
the ages at which these accidents may occur, but think I am 
safe in saying that the older the patient may be who has mumps; 
the more danger he will be in, of its receding and becoming 
formidable. It is therefore best to expose children to the con- 
tagion when they are young. 

TREATMENT. 

In children under eleven, or twelve years of age, I have 
never seen mumps produce much fever, or cause very great 
inflammation. I have advised emolient poultices, applied 
warm, and have never had any reason to change this prescrip- 
tion. A poultice of light bread, boiled in water or milk ; or of 
corn meal made into mush, answers every purpose. If there 
is much fever, a light cathartic should be given. A dose of 



ERYSIPELAS. 557 

castor oil, or a Seidlitz powder, or of magnesia and rhubarb, 
will have sufficient activity. 

Where the patient is grown, or nearly so, we are always to 
bear in mind the liability of this disease to fall on the breasts or 
testicles. If, in these cases, the fever is high, a brisk cathartic 
should be given. Cream tartar and jalap is probably the best; 
but salts and senna, or castor oil, will answer. The patient 
should remain still, and avoid any fatigue or effort of any 
kind. 

If the disease falls on the breasts, they are to be treated with 
warm fomentations, by wringing flannels out of hot water/and 
applying them for an hour or more. Then apply a warm poul- 
tice, or if more convenient, dress with cabbage leaves. A 
similar mode of treatment is applicable to the testicles. Steam 
from hot water, or a hot brick thrown into cold water in a foot 
tub, over which the patient may sit, covered with a blanket, 
will answer very well. . When the patient is removed, care is 
to be taken to support the inflamed part, and avoid the pain 
which its hanging loose will occasion. This is still to be re- 
membered when the patient gets on his feet. A bandage to 
suspend the part should be worn for many days. 

I have advised according to the experience I have had, and 
I believe according to the best authority, the application of 
warm, and not cold remedies, to the inflammation caused by 
mumps. I think there is a peculiarity in this inflammation. 
It never produces suppuration, even in the breasts, which are 
so liable to suppurate from other causes. I think I can say, 
that these applications are more agreeable and comforting, than 
those which are cold ; they are, at any rate, perfectly safe. It 
may be well to add, that the pain in the testicles is sometimes 
very severe, and that a full dose of laudanum may be admin- 
istered with great benefit. 

On looking at what others have written on this disease, I 
find that it is represented as being more formidable than I have 
seen it. I shall, however, content myself with what has been 
said, leaving worse cases, if they do occur, to be treated with 
more active remedies, according to circumstances. 



ERYSIPELAS— SAINT ANTHONY'S FIRE. 

This disease, though consisting in an inflammation of the 
skin, seldom penetrating to deeper organs, is, in many instan- 
ces, truly formidable. It sometimes prevails as an epidemic, 



558 ERYSIPELAS. 

attacking numerous persons about the same time ; and, in these 
cases, it is apt to be more severe. . The attack, at such times, 
is almost always restricted to the face, extending far over the 
hairy scalp. At other times, and when there is nothing epi- 
demic in its character, the disease occurs in certain individu- 
als, who, from some unknown cause, become exposed to it. In 
these cases, it is apt to be milder, and to assume rather a 
chronic form, happening on an} T part of the body, and spread- 
ing sometimes to a very great distance. 

The premonitory signs which usually precede an attack of 
erysipelas, are lethargy, and the usual attendants of such a 
state. The disease sets in with chilliness, frequent pulse, and 
all the symptoms of an approaching inflammatory disease. Af- 
ter many hours, a redness appears on the face, sometimes on 
the side of the nose, at others, on the eye brows. By this 
time, the disease has assumed symptoms more formidable; the 
fever has become considerable; pain* in the limbs, and dis- 
tressing headache, become also leading symptoms. In the 
worst cases, delirium comes on, even before the inflammation 
in the face has assumed its formidable appearace. With this 
state of things, we have vomiting, and, in some instances, 
diarrhoea. The redness and swelling of the face, makes rapid 
progress ; in twelve hours I have seen the face so distorted, and 
the dimensions of every feature so augmented, that the near- 
est friend could not recognise the person attacked. The pain 
now becomes more intense in the particular seat of the disease, 
in the skin, which is swollen to a thickness and extent hardly 
witnessed in any other disease. These symptoms go on in- 
creasing, for one or two days ; they remain at their height, for 
one or two days more ; and, after the fourth day, the inflam- 
mation generally subsides. The skin however has suffered all 
the consequences of a severe inflammation ; the epidermis is 
thrown off, and a greater part of the hair of the head, many 
times, drops out. Such is the course of an ordinary inflam- 
matory erysipelas. 

In other cases, the disease assumes still a greater malignity* 
From the first, the pulse becomes exceedingly rapid ; the 
strength fails ; the mind fails ; the inflammation, instead of the 
scarlet redness that might be expected, assumes a livid hue ; 
the mouth and tongue present all the appearance of the worst 
state of typhus. The tongue, especially, growing so black as 
to have acquired the name "black tongue" for this disease, 
when of late it has appeared at the North and West. This 



ERYSIPELAS. 559 

form of the disease is exceedingly fatal, frequently carrying off 
its subject in three or four days. 

Some individuals are peculiarly subject to an inflammation 
of this kind, differing, I have no doubt, in its remote cause, 
and, differing considerably in its symptoms. In these cases, 
the attack is every way more moderate. The disease may 
arise in any part of the body, extending more or less widely ; 
the part becomes painful, the skin a little thickened, and the 
redness manifest, although not very intense. In this form, the 
disease spreads in all directions. The part into which it runs, 
is to go through the same term of time, and the same extent of 
inflammation, as that on which it first originated. The dis- 
ease, in many cases, seems to give way at the point on which 
it originated ; the inflammation and tenderness cease ; the part 
becomes pale, and the tenderness is extended to the parts on 
which the disease has last seized. I have thus seen it pass al- 
most over the whole body, consuming three or four weeks in 
the process, and being entirely well on the parts on which the 
inflammation first originated, long before the disease has come 
to a close. 

In the epidemic disease, or that in which it becomes the 
disease of the season, or particular time, it is apt to be charac- 
terized by a sore throat, which does not, as I have observed, 
attend it at other times. Coma is also not an uncommon symp- 
tom, in these cases. It has been doubted whether the disease 
does not become contagious ; but I have no evidence myself 
that it has ever been so. 

The termination of this disease is generally by resolution. 
The inflammation gradually subsides, leaving the parts unbro- 
ken, and in a tolerable state of soundness. In worse eases, 
however, the disease tends to a destruction of parts. The skin, 
especially over the head, is sometimes elevated, and pus of 
an ill digested and thin glairy kind formed under it. It will 
extend far and wide, unless let out by a free opening in due 
time. In other instances, blisters filled with bloody serum, 
appear on the surface. Spots of mortification occur. This I 
have seen happen on the feet. 

TREATMENT. 

Very generally erysipelas is a highly inflammatory disease, 
and to be treated as such. On the first day, a copious bleed- 
ing from the arm is necessary. Cathartic medicines should 
also be given ; and here it has been observed, that the neutral 



560 ERYSIPELAS. 

salts., and other water discharging cathartics, are preferable to 
calomel. My preference, in cases of very high inflammation, 
is decidedly in favor of the antimonial mixture, given to pro- 
duce vomiting, and afterwards to protract the nausea, accord- 
ing to the violence of the case. This course of treatment will 
scarcely be necessary longer than two or three days ; for, at 
that time, the disease has reached its height, and will decline, 
if too much damage has not already been done to the parts. 
At this stage, the color of the inflammation will change. It 
will become somewhat pale, the surrounding parts frequently 
become soft and doughy, resembling dropsy. Stimulants, 
especially carbonate of ammonia, are prescribed at this stage. 
I would have no hesitation in administering, in a moderate 
way, brandy and water. 

In the malignant form of the disease, where the pulse be- 
comes exceedingly feeble and rapid, where the powers seem to 
yield without a struggle, and the inflammation from the first 
assumes something of a livid hue, we are debarred even from 
the first the use of the evacuants we have referred to. Opium 
is I have no doubt in this case the best remedy. I should not 
hesitate to prescribe it, even in the face of any degree of de- 
lirium which might be present. Sulphate of quinine should 
also be used in this case. Take of quinine twenty grains, di- 
vide into six doses ; give one dose every four hours with twen- 
ty or thirty drops of laudanum in each dose. At the same 
time the parts should be kept warm, by hot fomentations or 
warmth in a dry form. For it is to be recollected that although 
we have before us, the skin in a state of great tumefaction, the 
circulation is in the mean time so feeble, inert, and failing, 
that every means of adding to its force, becomes necessary. 
Of these means, the application of heat in the way indicated, 
is by no means to be neglected. 

As to the local remedies which may be applied to this in- 
flammation, it is acknowledged that they have been less effec- 
tual for its relief than might have been expected. The inflam- 
mation will run its course and terminate at its time. The ap- 
pearance of blisters, on the surface and sometimes the cracking 
of the skin, and the flowing of serum from such cracks, over the 
surface requires some particular attention ; for these blisters and 
these cracks may lead to spots of mortification and ulceration. 
Still physicians have been left to the simple application of absor- 
bent powders to absorb such matter as may flow from these 
blisters, and to close such cracks as may form in the skin. 
Starch has been thought as good an application for this pur- 



BOIL. 561 

pose as any other. I have long been in the habit of accom 
plishing this purpose, by another means which I think much 
more effectual and neat. Take an ounce of lapis calaminaris, 
put it into four ounces of proof spirit, shake it well together, 
pour a portion of it into a saucer, and apply this to the inflam- 
ed surface with a feather. The spirit will soon evaporate, 
leaving the part covered with lapis calaminaris in a dry ad- 
herent form. This I have found the best protection to the 
skin in this disease. The formation of matter which some- 
times occurs in this disease, should be met promptly by a free 
opening through the skin for its discharge. The spots of mor- 
tification which sometimes succeed, are to be treated in the 
same manner as if they had occurred from any other cause. 
The erysipelas is soon gone, and the mortification and morti- 
fied and dead slough, are to be thrown off by the powers of 
nature. Where the surface so affected is not large, there will 
be no danger ; it will be thrown off in due time, and the pa- 
tient recover. 

In the chronic form of this disease to which allusion has 
been made, the disorder assumes a much lower grade. The 
fever which attends it, although inflammatory, is not violent. 
It should be treated with the antimonial mixture, given in the 
usual form from time to time. But I do not agree with the 
maxim which forbids the use of calomel in these cases. I 
think it should be used to the extent, that it can be used with- 
out producing considerable salivation — three or four grains a 
day may be given for four or five days in succession. If it is 
thought very desirable to avoid salivation, the remedy should 
be then suspended for a time. 



BOIL— FURUNCULUS. 

The boil, or furunculus, as it has been termed by medical 
writers, is a very common and painful complaint of the skin. 
It is liable to occur to persons apparently in the highest health, 
and frequently takes place in succession, several happening 
about the same time, to be followed by others. They occur 
most frequently about the head and neck, or under the arms ; 
but no part of the body is free from their attacks. 

Although exceedingly painful, boils are attended with no 
danger ; they proceed rather slowly to suppuration, and then 
readily heal. But there is a marked variety in different cases ; 
36 



562 boil. 

ihe most common and least painful, makes its appearance as a 
small tumour in the skin, which will be red from the first. 
This tumour may be as small as a pea, or as large as a walnut, 
and painful in proportion to its size. After six or eight days, 
it will be found to be soft, and contain matter ; but there will 
be no blister on the surface. If at a proper time, a smalL punc- 
ture is made into this species of boil with a lancet, the pus, by 
the application of very gentle pressure, will escape, and the 
place heal without leaving a scar. But there is a more pain- 
ful boil, which is also very common. In this there is, from 
the first, a very prominent and tender point on the skin. Very 
soon, a small blister, sometimes a pustule with yellow matter, 
not larger than the head of a pin, is seen on the top. ' At the 
same time, on taking hold of the part, a considerable tumour 
will be felt, involving the skin and a portion of deeper seated 
tissue. This painful tumour progresses slowly to suppuration; 
and after a week or ten days, a small portion of matter may be 
made to escape through an opening made by the lancet, or 
through one or more small holes, which have been made by 
the disease. But the end is not yet ; there remains to be dis- 
charged, a considerable portion of dead matter, or as it has been 
termed a core. This will be detached after two or three days, 
or perhaps another week ; and after its discharge, the cavity 
left will soon be filled up and heal. This species of boil has a 
very great resemblance to the anthrax, or carbuncle, which we 
are yet to describe. 

TREATMENT. 

There are few diseases over which we have less control than 
boils. Emolient poultices, if they lessen the pain, are apt to 
protract the term of the suppuration ; and stimulating appli- 
cations are probably more painful than beneficial. The di- 
vision of the boil with a knife, is an operation so painful and 
unnecessarily barbarous, that I have never allowed myself to 
see it performed. This operation is I believe generally aban- 
doned, and patients suffering with boils, are left to see them 
take their own course. I think there is some benefit in a plas- 
ter of wax and lard, spread on a very thin rag, and kept neatly 
applied to the part. Where the boil is on the face, or other 
part in which it is desirable to avoid its leaving a scar, care 
should be taken to discharge the matter by the smallest orifice 
which will answer. I have used a needle for this purpose, in- 
stead of a lancet. When the skin is perforated with several 






CARBUNCLE. 563 

holes, the surface should still not be divided with a lancet, but 
the core allowed to soften, so that it may pass out through the 
smallest orifice. The scar will, by this means, be much 
smaller. 



CARBUNCLE— ANTHRAX. 

This disease has been termed a gigantic boil. The resem- 
blance it bears to a common boil, is very great ; but it is a dis- 
ease far more formidable. It is less subject to attack various 
parts of the body ; I have never seen it, except on the nape of 
the neck, between the shoulders, or on the abdomen. It at- 
tacks principally the aged, and the corpulent ; but does not 
confine itself to the rich and well fed. 

On its first appearance, anthrax is a broad flat tumour, not 
readily discriminated from Saint Anthony's fire. In a few 
days, however, the extreme hardness, and fiery redness of 
the part, will make its nature sufficiently obvious. It will pur- 
sue its own course to suppuration, which sometimes requires 
two or three weeks. At the end of this time, several small 
openings will be found, through which an ill digested pus will 
escape. The quantity of matter discharged, is very small, in 
proportion to the tumour ; but, by degrees, the skin will give 
way, and expose an enormous core, or slough, at the bottom of 
the ulcer ; sometimes three or four inches in diameter. This 
separates by a slow and tedious process, after which the parts 
unite and are healed. 

The general disorder of the system, which attends anthrax, 
corresponds with its extent and position. During the first 
days, the fever is considerable, and the pain very great. As 
it progresses, the fever may be less, but the pain and irritation 
are intolerable. 

TREATMENT. 

The treatment of anthrax should correspond with the gene- 
ral symptoms present. During the first two or three days, 
some gentle cathartic may be administered ; but the violence 
of the pain is to be met by a proper use of opium. Sixty drops 
of laudanum at night, or once in twelve hours, if the pain is ex- 
treme. When the strength of the patient seems to fail, there 
should be no hesitation in giving stimulants and tonics for his 
support. Quinine has been recommended ; and, for a few 
days, I should think it the best remedy. But if the case con- 



564 scurvy. 

tinues, other stimulants and tonics deserve a preference. The 
best of these is found in any kind of good spirits ; but if the 
patient prefers it, there will be no objection to the use of Port 
wine, or even porter. 

The local treatment of this disease, differs but little from 
that of the common boil. During the first stage, I know noth- 
ing better than a common plaster of simple ointment. After a 
considerable portion of the skin has given way, and the dead 
slough still adheres, tincture of myrrh, or other stimulating ap- 
plications, may be used. A strong solution of lunar caustic, 
may be applied once or twice, These and other exciting 
remedies, may promote the throwing off, of the dead slough ; 
but the disease will be found at last, to require its own time. 

Of late, it is advised, to divide the anthrax into four quar- 
ters, by cutting down through it with a knife. The operation 
is said to be useless, unless the tumour is thoroughly divided. 
This cruel operation requires the sanction of time and experi- 
ence. I do not advise it. 



SCURVY- SCORBUTUS. 

There is some reason for believing, that the remote causes 
of disease are undergoing a gradual change ; and that while 
new diseases are from time to time making their appearance, 
old ones are losing their virulence, or disappearing. The dis- 
ease under consideration gives countenance to this remark. 
Who has not read of the havoc from scurvy, in besieged 
cites, and in ships on distant voyages ? Who has forgotten the 
siege of Thorn, where thousands perished from this disease ; 
or the fearful accounts of voyages in high latitudes, where the 
tedious winter nights were rendered horrible by the despair 
and death arising from scurvy. At the present time, this dis- 
ease is looked on with less apprehension, for its ravages are 
stayed. The mode of preventing and curing it, is better un- 
derstood ; and I think, it is less apt than formerly, to make its 
appearance. It is no longer, so far as I know, a fatal disease 
in any country ; but it is still frequently seen, and is a proper 
object of medical advice. 

CAUSES. 

The history of scurvy is full of interest. It was at no re- 
mote period a formidable disease ; and, at sea, more dreaded 









scurvy. 565 

than the elements, or the enemies of navigators. It is no 
longer a just cause of alarm, either at sea or on land. Its 
causes are in a great degree removed ; and when it does oc- 
cur, we have remedies in which the greatest reliance is placed. 
The causes to which scurvy has been attribuced, are princi- 
pally these. Bad and unsound food, want of cleanliness, damp 
and cold apartments and clothing, despondency, idleness or 
excess of fatigue, want of vegetable food, and, in fine, all the 
hardships of oppressive governments, and destitution. The 
progress of civilization has lessened or removed these causes. 
The clothing of mankind is more than doubled ; even the poor 
have changes equal to all their necessities. Vegetable food is 
now provided for all, and the comfort of the soldier and the 
sailor is no longer neglected. Medical writers say, that in 
consequence of these great inprovements, scurvy is no longer a 
plague upon the earth. A few scattering cases are met with, 
but they excite no fear, and produce little danger. It may be 
true, that these great changes have produced the effects attri- 
buted to them ; but I suspect there lies beyond that a deeper 
cause. I think the causes which formerly gave rise to scurvy, 
have grown weak from some unknown change in the remote or 
natural causes. The reforms spoken of are great ; but they 
are not so universal as to hinder the appearance of scurvy on 
many occasions, were it as ready to occur now as formerly. 
I think the disease is slowly ceasing upon the earth. 

DESCRIPTION. 

Indolent and corpulent persons are most subject to scurvy. 
The slightest cases are attended with depression of spirits ; 
and more violent ones produce the deepest despondency. The 
first appearance of the disease, is a softening of the gums, with 
a breath extremely fetid and disagreeable. Blood oozes from 
the gums on the slightest injury, and the teeth become loose 
and ready to fall out. If the case grows worse, pains begin to 
be felt in the limbs, and purple spots make their appearance on 
many parts of the body. The countenance becomes sad, the 
face pale and bloated, and the pulse slow and feeble. Tu- 
mours now make their appearance like bloody contusions, and 
finally, in extreme cases; burst, with considerable discharge of 
blood. These symptoms threaten speedy dissolution ; but in 
the two cases in which I have witnessed them, they were ar- 
rested by remedies. I have never witnessed a death from 
scurvy. 



566 scurvy. 

The first thing to consider in the treatment of scurvy, is, the 
removal of all the remote causes of the disease. The mind 
should be buoyant, and the person happy ; but these requisites 
can only be approached by suitable regulations. They are not 
easily supplied to convicts, amongst whom I have oftenest seen 
the disease. Negro slaves are at least as free from it as their 
owners. But there are hopes for the slave and the convict ; 
and, with a little judgment, the state of mind suited to a 
speedy recovery from scurvy, may be induced, even in these 
subjects of the disease. The next object is to provide for a 
comfortable, warm and dry residence, with sufficient and clean 
clothing. The next requisite is proper food. This should be 7 
in part at least, of fresh meats, and a sufficient portion of vege- 
tables. The frequent occurrence of the disease at sea, has 
fixed on salted meats and dry bread, as the cause of scurvy. 
But every day's observation shews, that these are not of them- 
selves "a common cause of scurvy. The slaves of the South 
are fed on rations of salted meat and bread. They eat very 
little vegetable food, because they are careless and do not pro- 
vide it. The abundant exercise in the open air, which then- 
occupation supplies, hinders scurvy. The weight of authority, 
however, is in favor of a full allowance of vegetable food. 
There is no benefit in abstaining from salt. It should be added 
in reasonable quantity to the food taken. The great faith 
which was formerly given to certain vegetables as food, has 
not been maintained by experience. The common garden 
vegetables, now almost universally used, answer every expec- 
tation. 

REMEDIES. 

Do not smile at the simple prescription I offer for a for- 
midable disease. Limes, oranges, lemons, and shaddocks, 
contain in them the sole remedy now used for the pre- 
vention and cure of scurvy. These fruits contain the citric 
acid, and probably owe to this their curative power in scurvy. 
An ounce of lime juice, with sufficient sugar and water to ren- 
der it agreeable, is a dose, and may be taken three or four 
times a day. If fresh limes or lemons are at band, they may 
be used to about the same extent. The shaddock affords a 
sour juice, which may be obtained from the fruit in any con- 
venient way; and the sweet orange which supplies a juice suf- 
ficiently palatable of itself, has been found equal in all respects 
to any of the rest. These fruits abound in warm climates, 
and afford the means of safety to persons exposed to the causes 



PURPLES. 567 

of scurvy, all over the world. Lime juice is considered an es- 
sential article of sea stores, and armies ought not to be without 
it, especially in high latitudes. This remedy has by its un- 
questionable power in curing scurvy, driven from use, every 
pther ; and it is amusing to see able writers defending it 
against the doubts raised by certain chemical experiments, 
which seem to show, that lime juice ought not to cure this dis- 
ease. Many trials have been made with other acids, especially 
the sulphuric ; but all these, seem to have increased the con- 
viction, that acids are of very little service, except they are of 
the right kind. The lemon, the lime, the shaddock, and the 
orange, furnish the true and only specific for scurvy. 

Certain symptoms of scurvy require particular treatment. 
Costiveness is a common attendant on the disease. This 
should be removed by any gentle cathartic. I object to calo- 
mel from having seen it excite a violent salivation. But I have 
seen it used without any injury of this kind; and think there 
will be no great danger in using it as a component part of a 
cathartic pill. But the food of the patient should be so full of 
vegetable matter of some kind, as to keep his bowels sufficient- 
ly open, without medicines. The local disorder of the gums, 
is some times considerable. A tooth powder composed of 
equal parts of alum and myrrh, should be used, daily, with a 
brush. Where the gums are very tender, I have seen them 
rubbed with fine salt, by means of the finger alone, with im- 
mediate benefit. The blotches of purple on the skin, call for 
no particular remedy. They give way under the general treat- 
ment. 



PURPLES— PURPURA. 

Purpura is seldom a disease of much danger, but is fre- 
quently present in persons who enjoy tolerable health. It is 
known by the blue spots it presents on the skin, and resembles, 
in the strictest sense, slight bruises, as if the skin had been 
pinched. In some instances, it appears in the mouth or eyes, 
spreading over the whites of the eyes, or in-side of the lips, 
with reddish bloodshotten spots. Each spot seems to be the 
work of a limited hemorrhage, from the bursting of some small 
vessel under the skin. By degrees these spots become pale, 
clouded and greenish, and disappear to be followed by others. 
I have met with two cases, in which this was a formidable dis- 
ease. It occured in children, who were affected with it from 






-568 PURPLES. 

birth. Their limbs were almost always disfigured with pur- 
ple, or greenish blotches ; and it often appeared that such spots 
would arise from the pressure of the fingers, in lifting the 
child. The slightest wound would give rise to a dangerous 
hemorrhage, and one of these patients was finally destroyed, 
by a slight blow on its forehead, which did not break the skin. 
In this instance, a fatal hemorrhage was brought on by a slight 
contusion, the blood flowing under the skin, and producing an 
enormous dark tumor, closing the eyes, descending along the 
face and neck to the body, and producing the most horrible de- 
formity I ever beheld. The patient survived the injury only a 
few days. A second child, in the same family, had a similar 
affection ; but by careful management was preserved during 
its early years, and the disease finally disappeared. 

This disease bears so much resemblance to scurvy, that it 
becomes of some consequence to be able to discriminate be- 
tween them. The principal difference manifests itself in the 
state of the gums. Purpura is not attended w T ith any disorder 
of the gums, while in scurvy, spongy gums are almost always 
present. 

TREATMENT. 

In most cases of purples, there appears to be scarcely any 
disease present ; but, in some instances, there is a degree of 
fever, attended with great sluggishness, while the disease con- 
tinues. In such cases, brisk cathartic medicines, such as rhu- 
barb and magnesia, or cream of tartar and jalap, will be use- 
ful. If the blotches increase, and the patient appears feverish, 
bloodletting may be practiced. Leeches are not to be applied 
in such cases ; for the bites of those animals, might produce a 
hemorrhage which could not be controlled. In other respects, 
this disease is to be treated on general principles ; and the low, 
protracted disease met with the alteratives and tonics, which 
are found useful in similar disorders. It has been observed, 
that mercury, which is injurious in scurvy, has been found a 
valuable remedy in purpura. It may be given till a slight 
salivation is brought on. If the patient is grown, give a grain 
of calomel, twice a day, till a slight salivation appears. I have 
seen the best results from travelling, and the temporary use of 
mineral water. The chalybeate waters are to be preferred, in 
these cases. 



MrLK SICKNESS. 569 

NIGHT-MARE— INCUBUS. 

Every one will expect to find night-mare treated of in 
this work ; but I am by no means certain, that it has an exis- 
tence independent of other disorders. The most common 
cause of this disease is indigestion, particularly, a hearty sup- 
per remaining undigested in the stomach of a feeble, nervous 
person. Certain disorders of the heart are thought also to 
produce it; but these cases are not so common. 

The attack of incubus, commonly takes place soon after the 
subject of it falls to sleep. Slight cases produce a sudden 
starting from sleep, with a sensation of falling, or of the attack 
of some dangerous animal — a rabid dog, or a reptile. In 
worse cases, the patient lying on his back, dreams or thinks, 
he feels on his breast a heavy weight, or horrible monster, 
which he is unable to rise with, or throw off. His struggles 
become obvious to any one who may be looking on ; and he is 
relieved by a sudden shake to arouse and awake him. If there 
is no friendly hand to do this, he will in a short time awake 
in great anxiety, and much exhausted. If he composes him- 
self to rest, he is in danger of falling again into the same 
state, and thus passing a great part of the night in this kind of 
disturbance. The variety of symptoms in different cases is 
infinite, and need not be described. * 

The treatment of night-mare, is to be directed to the remo- 
val of its remote causes. Slight cases are hardly a subject of 
medical advice. When the attacks are so distressing, as to be 
a cause of special fear to the patient, he will demand a reme- 
dy. The first prescription, is the avoidance of heavy suppers ; 
or what is better, a total abstinence from that meal. If the 
patient has indigestion, he will seek relief, from the remedies 
for that disease. 



MILK SICKNESS— TREMBLES. 

I have never met with this disorder, and should judge from 
the authorities which I have been enabled to consult, that it is 
very little understood. It is said to be a disease of cattle, and 
to be communicated to men who eat their flesh, drink their 
milk, or eat the butter made from such milk. The animal 
giving the milk is not always sick ; but in some cases, is soon 
afterwards seen to tremble and to sink down and die. The 
disease, as it appears in men, is to be ranked amongst those 
arising from poisonous food. 



570 MILK SICKNESS. 

The cause of milk sickness, is as yet undiscovered. It is a 
disease of autumn, and sometimes of summer, but I believe 
never occurs in winter or spring. It has, without sufficient 
proof, been charged to the effect of various plants eaten by the 
cattle. It prevails in certain districts of country, especially in 
parts of i\labama, Kentucky, and Indiana. It is much feared 
in certain settlements of the mountainous districts of Georgia 
and Tennessee ; and I have been shewn several localities, 
where its fatal effects have been felt. These places have all 
been situated in the rich valleys of rivers, or in the narrow val- 
leys near high mountains. A gentleman residing in one of 
these places, said to me that his fear of the disease was such, 
that in the summer and autumn, he dared not taste either 
milk, butter, or beef. He informed me that on one occasion, 
he attempted to drive his cattle ; they became unmanageable, 
and ran till they were heated, and very much fatigued. Sud- 
denly, above half ©f the drove were taken with trembling, and 
several died in a few hours. I was shewn a house in which 
two persons died from taking a portion of the milk of a cow 
thus diseased ; and another, in which three had experienced 
the same fate. Still there is some incredulity, in regard to the 
existence of the disease in question, some authors attributing 
the diseases which have been charged to milk or beef, to the 
malaria of a sickly locality. Doctor Drake has been quoted 
as authority, that the disease disappears in countries which are 
reduced to cultivation. Judging as impartially as I can, from 
all the facts which I have seen stated on credible authority, I 
think there can be no doubt of the existence of the disease, 
which has been called milk sickness ; and that it affects cat- 
tle, and men who eat of their milk, or butter, or flesh. 

The disease produced by eating of the milk, butter, or flesh, 
of the cow affected with it, is described as a fever, sometimes 
attended with vomiting and purging, and terminating in death 
in a few days ; in other instances, the case is prctracted to 
many weeks of duration, leaving great nervous prostration, 
which is scarcely ever entirely gotten rid of; in every case, 
there is a tremor and prostration of strength from the first, 
which is so much greater than is usual in other diseases, that 
it is thought the distinctive feature of this. 

A few words will suffice for the treatment of this disease. 
If it is discovered before the food, which gives rise to it, is di- 
gested, a brisk emetic should be given. Twenty or thirty 
grains of ipecac will answer. This should be followed by a 
mild cathartic — calcined magnesia, with a portion of rhubarb, 






BITES OF SERPENTS AND SPIDERS. 571 

if the patient does not seem too much exhausted to bear its ac- 
tion. If the attack is. with vomiting, the magnesia alone should 
be given ; and after a free evacuation of the bowels, whatever 
remedies may have been given, give sixty drops of laudanum. 
After this, the patient is to be sustained by such stimulants and 
tonics, as the case may seem to require. If the strength is 
prostrated at first, and the disease seems to threaten a speedy 
dissolution of the patient, he is to be supported with brandy 
and other strong stimulants. If the progress of the disease is 
slow, a milder course will be proper. Mild stimulants, such 
as wine or porter, or vegetable bitters, with spices, will be 
proper. A decoction of cherry-tree bark, or of gentian, will 
be the best of these remedies. 



BITES OF SERPENTS AND SPIDERS. 

STINGS OF INSECTS. 

These injuries are so rare in cultivated countries, that little 
regard is paid to them by medical writers. But there are yet 
many parts of the South and West, in which poisonous rep- 
tiles and insects are too common and pernicious, to justify 
their being overlooked. 

Very few of the great variety of serpents in the United 
States, are poisonous. At the South and West, I know of but 
two genera of poisonous snakes — the rattle-snake, crotalus hor- 
ridus, and the viper or coluber. Of the rattle-snake, there are 
three species, which are universally known from other reptiles 
by the rattle on their tails. But the viper or coluber is not so 
readily distinguished. Of this, there are four species, which 
are known to be poisonous ; the common viper, and the cop- 
per-head, which inhabit the high lands, and the brown or blunt 
tailed moccasin, and the cotton mouth ; both of which are 
amphibious, inhabiting small streams and low grounds. 
The bite of all other serpens found in the Southern States, 
is, so far as I know, not more poisonous than the bite of a 
rat. I fully concur with Catesby in the opinion that the 
danger from the bite of these reptiles, is very much in 
proportion to their size. I have never known death to 
happen from the bite of a small serpent of any kind. The 
water snake and the viper are sometimes found of considera- 
ble size ; and I have heard of one or two instances of death 



572 BITES OF SERPENTS AND SPIDERS. 

in children, bitten by these serpents ; but the ground rattle- 
snake, or small variety of that species, has never, as far as I 
know, inflicted a fatal wound on even a small child. The lar- 
ger varieties of rattle-snake, become dangerous from the time 
they are half grown. When they are three feet or upwards in 
length, I consider their bite, when it is fully inflicted, certainly 
fatal. There are instances in which persons have not died, 
though bitten by these large snakes ; but, so far as I have 
known the bite was but partially effected, one tooth on- 
ly taking effect, or other imperfection in the bite itself. Gene- 
ral Coffee, who resided for many years in one of our thinly 
peopled counties, where this species of snake abounded, in- 
formed me that he had known many cases of persons bitten by 
the larger variety of rattle-snake, every one of whom was de- 
stroyed. When the size of these monsters is considered, and 
it is seen that their teeth and sack of poison at their roots, are 
in due proportion, we cannot be surprised that their bite is fa- 
tal. No one can live, into whose flesh so great a quantity of 
poison is thrown. 

REMEDIES FOR SNAKE BITE. 

The sudden effect produced by the poison introduced into 
the flesh by the bite of a snake, renders the use of remedies 
difficult or unavailing. The bite of a large rattle-snake fre- 
quently produces death in one hour. It produces intolerable 
pain in a moment, with sickness at the stomach, blindness, 
pain in the region of the heart, and death. A hunter bitten by 
one, had steadiness to level his rifle and fire with effect ; but 
he was found dead in less than a hundred yards of the spot. 
If the patient lives a few hours, violent swelling of the limb 
ensues — if he survives a day, a violent fever follows ; and this 
sometimes destroys life, after an agony of three or four days. 
It is for these awful cases, we are in want of remedies. Al- 
most every herb in the field, has been celebrated for the cure 
of snake bites. None of them are entitled to the name of reme- 
dies. They neither destroy the poison, nor remove any of its 
ill effects. The first thing to be attempted,, is, to draw out the 
poison from the wound. Not a moment is to be lost — let the 
part be washed, and apply suction, either with a cupping in- 
strument, or the mouth of a fiiend. This operation has been 
proved to be safe. If a toe or finger is the onfy part injured, 
and the serpent be of the largest size, let the toe or finger be in- 
stantly cutoff. But if much time is lost, these operations be- 



BITES OF SERPENTS AND SPIDERS. 573 

come useless. The swelling of the part is not a cause of dan- 
ger. It has been recommended to bathe the wound and swel- 
ling with water of ammonia, or common harts horn. I know 
nothing better ; but have not a great deal of faith in this. A 
volatile liniment made of equal parts of sweet oil and water of 
ammonia, has been used with apparent advantage. I have 
tried it, and was satisfied that it afforded relief. Where the 
swelling is considerable, after the fever has abated, I think hot 
applications are best. Cloths dipped into warm brandy and 
water, may be applied for some hours. We are as much at a 
loss for internal remedies. Sweet oil has lately been recom- 
mended ; but I do not know any thing which has any special 
power in these cases. If the patient appeared to be sinking 
soon after the wound was inflicted, I should have strong hope 
from diffusible stimulants. I should prescribe laudanum and 
brandy, in full doses, to such patients. And should a fever 
arise, as I have no doubt it has sometimes happened, I should 
give such depleting remedies as its grade seemed to warrant. 
Give an emetic, and follow it with a cathartic. These cases 
are to be treated on general principles— no nostrums have 
been discovered for them. A few words may be added on the 
remedies for the bites of smaller reptiles. I have said that 
these bites are not dangerous. They get well of themselves. 
But the pain which attends them is very great, and the swel- 
ling, and injury of the limb sometimes permanent. I have 
seen several limbs, which, from this cause, were permanently 
swollen, and often sore and painful. These cases commonly 
show their worst symptoms in a few hours. The pain is at its 
worst in a few minutes ; and the swelling at its height in a few 
hours. A comparative degree of ease follows the cessation of 
the swelling ; and I have seen a child sleep soundly in two 
hours after being bitten by a ground rattle-snake. The local 
injury is the worst part of these cases. I have thought that 
the bite of the water snake was most likely to produce perma- 
nent injury to the limb. It is not uncommon for the part in 
which the bite was inflicted, to run into a state of mortification, 
giving rise to extensive sloughing and loss of substance. But 
whatever injury follows, is to be treated according to the 
symptoms, without any regard to the cause from which it 
has originated. There is no evidence that any portion of 
the poison remains in the system. The injury it has done 
may remain ; and I have no knowledge of any special reme- 
dy for it. 



574 BITES OF SERPENTS AND SPIDERS. 

BITES OF SPIDERS. 

I have seen only two instances of injury from the bites of 
spiders. Of the great variety of these wonderful creatures, 
there are, so far as I know, very few which are poisonous. In- 
festing every house, every tree, every bush, and almost every 
plant, we go safely by night or day through their airy habita- 
tions, with but little fear of injury. In the two instances which 
I have seen, of dangerous symptoms from the bites of spiders, 
the insects were seen, and I think there is some certainty, that 
the description I received of them is correct. We have in our 
fields and woods a variety of the spider, whose body is of a 
shining black, with a bright red spot on the abdomen. It is 
about the size of a wild grape, or swan shot ; with slender legs, 
slow motion, and very feeble. It spins its web in the open 
air, from one bush to another, but without any thing remarka- 
ble in its form or strength. This variety of spider is not un- 
common, and was described to me by those who had been 
bitten, in language not to be mistaken. The feebleness, and 
slow motion of this spider, would render it powerless for harm, 
if no accident should bring it in contact with our persons. In 
both the cases in which I witnessed the danger of the wounds 
they could inflict, they were by accident thrown into the bo- 
som. My patients were both laborers, strong young negro 
men, laboring in the field in sultry w T eather. They were no 
sooner bitten, than the insects were destroyed ; but I took 
some pains to ascertain the kind of spider by which they had 
been bitten, and they each gave me the same account, agree- 
ing fully with the description I have given. 

The symptoms produced by the bites of these spiders, were 
alarming, violent pain at the pit of the stomach, oppressed and 
difficult breathing, with spasms of the muscles of the abdomen 
and back, so permanent and rigid, that the body could scarcely 
be bent. The pain in the part bitten was slight, and the total ab- 
sence of swelling or tooth marks, rendered it impracticable to 
ascertain the exact spot on which the injury had been inflicted. 
The symptoms of pain at the pit of the stomach, and difficult 
breathing, came on in a few minutes after the bite. One of 
my patients was bitten, or it may be, stung, on the back, and 
the other on the side. I saw each of them, in about two hours 
after the accident, and found their symptoms as I thought ve- 
ry alarming. 



STINGS OF WASPS, BEES, &C. 
TREATMENT. 



575 



. When called to my first patient laboring under the pain of 
being bitten by a spider, the medical reviews and newspa- 
pers were teeming with the evidences that ammonia or harts- 
horn,' was the sovereign remedy for bites of serpents, stings of 
insects, and indeed for all animal poisons. Time has not con- 
firmed these high claims ; but I gave my patient a tea spoonful 
of water of ammonia as soon as possible. Not finding him 
much better in half an hour, I commenced to cauterise the 
wound with lunar caustic. Not being able to find the exact 
spot, I took a spot as large as a dollar, and commenced rub- 
bing it with solid caustic, keeping the part moist so as to dis- 
solve the remedy. This process was continued till it was evi- 
dent an eschar would form. This required half an hour or 
more ; and my patient declared himself much better; By the 
next morning all symptoms of injury, had disappeared ; and as 
soon as the wound from the caustic healed, he was well. It 
was only a year or two till the second case happened ; and it 
was treated in the same way, with the same result. In the ap- 
plication of the caustic in the second case, ten or fifteen grains 
of the remedy, in powder, were mixed with powdered gum 
Arabic, and made into paste with a few drops of water. A 
plaster over this, confined it to the part, and it produced an 
eschar, which resulted in a shallow ulcer. It healed without 
difficulty. 

I was very much struck with the sudden relief given by 
these remedies, and attributed the cure to the caustic applica- 
tion. It requires more experience to decide the question ; but 
till more is known of the matter, I do not hesitate to recom- 
mend the same treatment to others, who may be bitten by spi- 
ders. If the caustic were not at hand, I should apply a rag 
dipped in boiling water to produce blistering, or any other ef- 
ficient and powerful caustic. 



STINGS OF WASPS, BEES &c. 

We have many insects that are furnished with stings which 
they use with great readiness, inflicting very painful wounds. 
The most common of these insects are wasps, hornets, bees 
and ants. The hornet is the largest and most daring of these 
insects, and produces a wound extremely painful ; and if a 



576 STINGS OF WASPS, BEES, &C. 

great number should inflict their stings at the same time, there 
might be danger of death. I have known a person who incau- 
tiously approached too near a nest of these insects, and was 
stung on the face by three or four of them. His face was sud- 
denly so swollen, that his eyes were closed ; and he could not 
have found the way home without the aid of another. In an- 
other instance, a man was stung on the ball of the eye. He 
was frantic with pain for about two hours, when the eye burst- 
ed affording him some relief, but destroying the sight. Wasps 
and bees are apt to be nearer to the residence of men, and their 
stings are oftener felt, than those of other insects. The wounds 
they inflict are painful, but not often dangerous. The only 
source of danger, is from the sting of a great number ; or its 
happening near the throat, producing a swelling which may 
impede respiration. I have seen a lady very near falling a 
victim in this way, from the sting of a single bee, near the an- 
gle of the jaw. 

REMEDIES. 

Judging from their effects, I should conclude that the poison 
of the viper, the rattle snake, and all other poisonous serpents 
is the same as that which is thrown into the flesh by stinging 
insects. The difference is in the quantity of the poison. The 
symptoms produced are the same — instant and violent pain, 
with a speedy swelling of the part affected, and constitutional 
symptom corresponding with the danger. I have therefore but 
little to add to what has been said of the treatment of the bites 
of poisonous serpents. I have thought bathing the pait with 
spirit of camphor, or water of ammonia, beneficial ; and I 
recommend these remedies. I have recommended cupping, 
or suction, in cases of bites from serpents. The same purpose 
is accomplished by placing over the place at which the sting 
has entered, a key, or other small hollow tube, and pressing it 
down violently on the skin. On examining, after a minute or 
two, a very small drop of transparent fluid will be found to 
have flowed from the wound. Whether this is serum from the 
blood, or the poison which has been thrown in by the insect, I 
have not ascertained. But if such an operation is performed 
on the sting of an insect within a few minutes of the time it is 
inflicted, no swelling will follow, and the pain will cease in a 
few minutes. Great benefit would arise from a similar mode 
of treatment to the bites of serpents ; but it should be done im- 
mediately, or it will be of no use. 



SALIVATION. 577 

SALIVATION— PTYALISM. 

Salivation is of two kinds, the one arising in the natural 
course of several disorders, and the other brought on by the 
use of certain medicines. It consists in a profuse How of saliva. 
This profuse flow of saliva arises in very different states of the 
system : that which is produced by mercury, is always at- 
tended with an inflamed state of the salivary glands, situated 
near the angles of the jaws, and under'the tongue. But there 
is a profusion of saliva in many cases in which this inflamed 
state does not exist : for instance, tobacco taken into the mouth, 
will cause a very profuse flow of saliva, when there is no evi- 
dence of any excitement, or inflammation of the glands. Cer- 
tain disorders of the stomach seem to produce the same effect: 
when there is nausea, there is very often a profuse flow of 
saliva. The disorders of which We are about to take notice, 
relate exclusively to the salivation which is attended with in- 
flammatory action of the salivary glands, and adjoining or- 
gans. 

The spontaneous salivation which is most frequently seen, 
occurs in infants during the teething stage. As soon as the 
tooth has made some growth, and long before it has made its 
appearance above the gums, an irritation of the mouth and ad- 
joining organs becomes manifest. The glands, especially about 
the angles of the jaws, are more or less swollen, and a profuse 
discharge of saliva takes place. At any period of life, any 
disorder that produces a similar excitement of these glands, 
will produce also a profuse salivation. When this discharge 
continues for a considerable length of time, it produces great 
irritation of the lining membrane of the mouth, and of the 
tongue. Aphthous sores make their appearance, are exceed- 
ingly tender, and a great aggravation to the sufferings of the 
patient. This occurs, as well in grown persons as in children. 
In almost every instance, the disease which has given rise to 
this species of salivation, is manifest. In the teething child, it 
is with great certainty referred to teething: in grown persons, 
the glands will be seen to be affected, but it is not always in 
our power to point out the remote cause. 

The remedies for this species of salivation are such, as tend 
to remove or limit the effect of the remote cause. In teething 
children, the treatment includes all the remedies for the disor- 
ders of the bowels, fever and teething which belong to that con- 
dition : they need not be repeated here, except so far as to re- 
mark, that the aphthous sores which attend this species of sali- 
37 



578 SALIVATION. 

vation, are quickly removed by the application of lunar caustic, 
or nitrate of silver. If the case .is at all serious, a dose of calo- 
mel should be given, and great reliance may be placed on its 
beneficial effects. Very little need be added in reference to 
this disorder when it occurs in grown persons. The removal 
of irritation, whether it be defective teeth, ulceration of the 
neighboring parts, or anything of the kind, should be first ac- 
complished, and the salivation will speedily disappear. 

It has not occurred to me to see a profuse salivation, with in- 
flammatory symptoms brought on by the use of any remedy 
except mercury ; yet we read that iodine, arsenic, antimony, 
and several other articles, when used for a length of time, pro- 
duce the same effect- The salivation brought on by mercury 
makes its appearance, first, by a tenderness of tbe teeth, espe- 
cially if any of them are defective,- and their apparent elevation, 
or spring, as it were, from the socket. The teeth appear to rise 
above their natural positions : at the same time the gums' be- 
come soft, the breath fetid, tbe patient is annoyed with a dis- 
agreeable copper taste in the mouth, and the glands of the jaws 
take on an inflammatory action. The flow of saliva depends 
upon the extent of this inflammation of the salivary glands. It 
is sometimes very profuse, extending to three or four quarts in 
twenty-four hours. This extreme degree of inflammation is, 
of itself, a formidable disorder, producing great swelling about 
the angles of the jaws, enlargement of the tongue, and a clench- 
ed state of the jaws, leaving tbe patient scarcely any capacity 
to open them. As the disorder goes on, aphthous spots make 
their appearance on the tongue, and on the lining membrane of 
the mouth. These very often become considerable sores, are 
exceedingly tender, and a great aggravation to the patient's suf- 
ferings. When this state of things occurs to young persons, 
especially to children from seven to fifteen years of age, great 
damage is sometimes done to the neighboring parts : the mor- 
tification sometimes involves the gums, the lips, and parts of the 
face, and even extends to the jaw bone, producing caries, by 
which in many instances large portions of the bone are destroy- 
ed. Great loss of substance frequently ensues, and in many 
instances a frightful deformity of the face is the result. These 
cases give rise to the necessity of a tedious surgical treatment, 
many times requiring serious operations for the removal of ad- 
hesions, which are formed in the course of the cure. These 
accidents are by no means so frequent as they formerly were : 
the use of mercury is better understood, and the article, I have 
no doubt, is used with much greater benefit. I should have ob- 



SALIVATION. 579 

served that children under two years of age, are not liable to 
these accidents. At any rate I have never known an instance 
of this species of injury from mercury in a person of that age. 

REMEDIES. 

When the mercurial salivation is fairly established, it is very 
little under the control of remedies. Of late, we are advised to 
give tincture of iodine, in doses often drops, three times a day: 
of this I have but little experience, and do not rely on it. The 
remedies which I have used are principally cathartics. These 
should be such as promote free, watery discharges ; cream of 
tartar and jalap, if the patient is manifestly strong enough to 
bear the use of it ; if not Epsom salts or Seidlitz powders may 
be substituted. It was formerly believed that sulphur had a 
special power in arresting salivation ! This opinion has lost 
ground ; but still 1 know no better cathartic iri ordinary cases, 
than cream of tartar and sulphur. These remedies constitute 
about the whole internal medicines which I am in the habit of 
using. Where the case has lasted a considerable time, and 
mortification has taken place in any part of the face, I think the 
addition of stimulants and tonics become necessary. Quinine 
is in my opinion the principal of these : from ten to twenty 
grains may be given in the course of twenty-four hours. To 
this, such doses of laudanum may be added as the irritation of 
the case, and the restlessness of the patient, seem to demand. 
The aphthous sores which appear in the mouth, are to be treat- 
ed with such styptic washes and astringent applications as are 
used in such cases. During the first week, I know no better 
application than strong tea, made of about twice the strength 
of that which we would use for nourishment. Such tea, to 
which a small portion of alum may be added, is also a useful 
gargle where the pain is very great : and this will be found 
very commonly the case. Laudanum may be added to these 
gargles : a tea spoonful of laudanum added to a tea cup full of 
tea, forms a very good gargle. — -A decoction of red oak bark 
will be found one of the best remedies of this description, and 
may be used in the same manner, advised for the teas above 
spoken of. But the patient should not be too often disturbed 
with remedies ; even the use of a gargle is attended with sev- 
eral hours of severe pain : and I think there is little benefit in 
using it more than once in twenty-four hours. The time which 
it takes to get rid of a high degree of salivation, varies in differ- 
ent cases : much improvement cannot be looked for in less than 



580 NETTLERASH. 

ten days, and many times the disorder continues with great ir- 
ritation twice this length of time. Few disorders require more 
patience in the patient, or his nurses, than this: the consola- 
tion is, that the remedy itself is commonly beneficial, and that 
the salivation will pas's off, leaving the patient in better health 
than it found him. 

I should have mentioned the proper regimen in these cases. 
A low, and fluid aliment is best and most convenient, during 
the first stage of the disorder. When the inflammation sub- 
sides, articles of more nutritive properties are proper. 



NETTLERASH— MAD ITCH— URTICARIA. 

It is always pleasing to me to be able to follow the authori- 
ties which have most credit in the medical profession. ' In the 
disorder of which we are about to speak, I feel wholly unable 
to follow these guides ; for in following these, I should not on- 
ly render the subject exceedingly intricate, but I fear go far 
astray from the true path pointed out by nature. I shall de- 
scribe urticaria as I have seen and experienced it. 

Nettlerash is known by the stinging pain it produces on the 
skin, resembling very closely that produced by the sting of 
nettles, and by the wales it produces. The disease may be 
divided into two varieties, the chronic and acute. In the 
acute form, the disease commonly makes its appearance after 
the patient has risen from bed, and been exposed to the cool 
air of the morning. If by any accident he is placed by a crack 
in the wall or window, through which a stream of cold air 
may operate on his neck or breast, the disease will make its 
appearance on the spot so affected. An intense itching is the 
first symptom, and this will presently spread down the arms 
or over the body.' It will soon produce an evident swelling 
in the skin, which may be felt on taking hold of it. The pain 
as yet is only an itching, and these wales will rise in patches 
frequently along where the nails have passed over the skin in 
scratching. A burning and itching pain is felt in this stage of 
the disease, which in some instances, tempts the patient to 
seek relief by bathing in cold water ; but this only aggravates 
the complaint, and frequently causes it to extend over the bo- 
dy, producing an indescribable pain and itching,. In some 
cases, a great oppression is felt in breathing — the patient is 
scarcely able to articulate a single word. All this will take 



NETTLERASH. 581 

place in the short space of half an hour, and this description 
is drawn from experience of my own — vivid in my recollec- 
tion, although it occurred when I was but a youth. If the dis- 
ease continues, the wales will die away in one place, and 
spring up in another, and after a day or more, a considerable 
fever will be found to be present. In this* way the whole skin 
is sometimes, as it were, thickened and rendered somewhat 
red, but without the tenderness that belongs to inflammation. 
In three or four days, such cases subside of themselves, even 
without the administration of any remedy. The patient is 
however left more or less disordered, and will be liable to fu- 
ture attacks of the same complaint. 

The chronic form of this disease, differs widely from that we 
have described. There are considerable varieties in different 
cases ; in some instances, the disorder makes its appearance 
as soon as the patient becomes warm in bed at night. A tor- 
menting itching with wales similar to those we have describ- 
ed takes place, and many times, continues with great irritation 
through the greatest part of the night. On rising from bed, 
and exposing himself to the cool air of the morning, the disease 
will disappear to make its return again at night. In this in- 
termittent form, the disease exists in many instances, varying 
in every way that can well be conceived. From the account 
we have given, the identity of the disease will be ahvays known 
by its close resemblance to the pain produced by the sting of 
nettles. 

CAUSES. 

Writers generally agree in attributing this disorder to an ir- 
ritation on some part of the intestinal canal which is by some 
means transferred to the skin. This, I have no doubt, is gene- 
rally the case; but in the acute form of the disease, I think it 
far from being certain, that the disorder has such an origin. 
In many instances, it appears to me to be wholly independent 
of the state of the stomach or bowels. In the chronic cases 
which I have seen, it has appeared to me to depend upon the 
health of the patient at the time ; even in these cases, I have 
not always been able to satisfy myself, that the bowels or 
stomach were more concerned than other viscera. A great deal 
has been said of the influence of certain kinds of food in pro- 
ducing this disease. It has so often happened to persons soon 
after feeding heartily on muscles, crabs, lobsters, and other 
shell-fish, as well as from eating pike, salmon, mackerel, and 
other fish of the highest orders, that we are bound to concede 



582 NETTLERASH, 

that this is a frequent cause of this disease ; still it has never 
occurred to me to witness it as arising from any such cause. 
It may be proper that I should observe here, that nettlerash 
frequently occurs in cases of bilious fever, and that in treating 
of that disease, the cases which happen to be affected with 
this symptom, are sufficiently discussed. 

TREATMENT. 

In sudden attacks of this disease, when there is good reason 
for supposing it to have arisen from improper food remaining 
still undigested on the stomach, it will be proper to administer 
an emetic. A dose of ipecac will answer the purpose very 
well, and should be given in sufficient quantity to act prompt- 
ly, so that its operation may be over as soon as possible. The 
physicians of the West Indies, who have seen this disease ari- 
sing from improper food oftener than others, advise the sul- 
phate of zinc or white vitriol, as an emetic in these cases. 
Twenty grains of this article may be given in water at a dose. 
Its effect will probably be prompt and satisfactory ; but in ca- 
ses in which there is no reason for supposing the stomach to 
be burdened with improper food, I object to the use of emetics 
or cathartics, and administer promptly a full and decided dose 
of laudanum — from sixty to one hundred drops according to 
the acuteness of the symptoms. The patient should be in- 
stantly placed in bed, and warm bricks, or something of the 
kind, placed around him, so as to bring forth as speedily as 
possible, a profuse perspiration. Probably every symptom of 
the complaint, will disappear under this treatment in two 
hours ; and if the patient is allowed to keep his place for a 
number of hours, and on rising from his bed will take a portion 
of brandy and water, he will probably have nothing more to 
apprehend from the disease. If the case requires an emetic, 
that emetic should as soon as possible be followed by the use 
of laudanum which I have here directed; and with this sim- 
ple form of treatment, I have found the acute form of urticaria 
uniformly subdued in one day — not remaining as authors tell 
ns for five or six, under the treatment they have advised, 
Other stimulants might be used in the place of opium. A 
West India physician has bestowed the highest commendation 
on capsicum or red pepper. Now I have no doubt, that this is 
a remedy of the first class, but I have been so well satisfied 
with that which 1 have used, that I have never tried it. Warm 
bathing has been of late recommended, and this also I have no 



BLEEDING AT THE NOSE. 583 

doubt, if practiced early, and not continued too long, will be 
highly comforting and beneficial to the patient. 

The chronic cases of nettlerash are much more difficult to 
manage. They sometimes last, in spite of any treatment I 
have been enabled to discover, for weeks or months, occurring 
from time to time at uncertain intervals, commonly every night; 
sometimes once a week or not so often. These cases are to 
be treated in reference to the general health of the patient, and 
so far as I have observed, such patients are never in high 
health. The paroxysm or attack of the disorder on going to 
bed, ma}* be beneficially met by a dose of laudanum ; but this 
cannot be repeated from time to time as often as it might be 
called for. I have used a variety of similar remedies in these 
cases. Camphor I regard as next best to laudanum. Water 
of ammonia or spirit of hartshorn, I have found equally bene- 
ficial ; but these remedies afford but temporary relief, and the 
patient returns to his bed the next night, with equal reason to 
fear another attack of his disease. I have tried, in these cases, 
a course of mercurial remedies, producing a slight degree of 
salivation, but the results have not been satisfactory. Iodine 
has equally failed me. At the present, I should hardly think 
it necessary to resort to these remedies. A general course of 
tonic medicines founded on the preparations of iron, with ex- 
ercise in the open air, is all that I have, at the present, to sug- 
gest. 



BLEEDING AT THE NOSE— EPISTAXIS. 

This is the most common of all hemorrhages, and scarcely 
requires any description. It is so various in degree, that in 
one case only a few drops of blood will flow; but in another a 
stream, or rapid succession of drops will continue even to the 
destruction of life. The quantity of blood which has been seen 
to flow from the nose, when it has continued for several days, 
is enormous. When the discharge is considerable, it will al- 
ways receive prompt attention, for every one knows that death 
is the consequence of its continuance. 

Bleeding at the nose occurs in various states of the system, 
and in some cases becomes habitual ; returning at intervals for 
months, or even }^e,ars.' It is most frequently a troublesome dis- 
order in boys, at or before the age of puberty. In these cases, 
the health becomes impaired, the countenance dejected, the 
face pale, the pulse full and bounding, and the disease danger- 



584 BLEEDING AT THE NOSE. 

ous, if not fatal. But all ages and sexes are subject to its at- 
tacks, and it should never be regarded as a trifling disorder. In 
many instances, it is thought to be a beneficial discharge, re- 
lieving internal and dangerous congestion in important organs. 
But these cases are not less worthy of attention than others, for 
the disorder which appears to be benefited by this hemorrhage, 
is very apt to return again, and probably with aggravated symp- 
toms. I knew an aged man who frequently had violent pain 
and fulness of the head, with bleeding at the nose, which gave 
him immediate relief. He fell a victim to a sudden attack of 
apoplexy. The state of health, of persons who have had re- 
peated attacks of bleeding at the nose, should always be par- 
ticularly studied, and remedies used to prevent the congestion 
and fulness, which are sure to precede the attack. 

BEMEDJES. 

The treatment of this disease maybe divided into that which 
is proper in the attack, and that which is required in the inter- 
val. The remedies suited to the interval, or time which inter- 
venes between one attack of bleeding and another, will vary 
according to the nature of the case. If it is a young legale 
with obstructed menstruation,- who is to be prescribed for, the 
removal of the obstruction is the first consideration ; and the 
remedies for that disease will probably hinder the return of the 
bleeding at the nose. If it occurs in an old person in whom an 
attack of apoplexy is to be apprehended, a light diet with ac- 
tive cathartics when symptoms of the attack come on, will be 
necessary. If the fulness of the head, drowsiness, or other 
symptoms of congestion come on, no time should be lost in 
opening a vein, and drawing a full portion of blood from the 
arm. Where the patient is a youth, and the fear of apoplexy 
is less, the treatment should be a little varied. The debility 
and emaciation which follow the attack, should be remedied 
with tonics and stimulants, especially preparations of iron. 
From ten to twenty drops of muriated tincture of iron, may be 
given twice a day. A glass of porter, or brandy and water 
before dinner, will also be proper. But where the case is at- 
tended with a low fever, and^pain in any particular part, the 
tonics and stimulants recommended will not be found benefi- 
cial. In such cases I have administered calomel, or blue pill, 
in broken doses, with great advantage. Four or five grains of 
calomel, every second day, till two or three doses are taken, 
will be sufficient. When the time for the attack approaches 



! 



BLEEDING AT THE NOSE. 585 

more active remedies are necessary. This time will be known 
by a throbbing of the arteries of the neck, fall pulse at the 
wrist, headache, drowsiness and other symptoms of plethora. 
At this time, give a cathartic of cream of tartar and jalap. 
The next day, commence with the antimonial mixture, and 
give two tea spoonsful, four times a day, for several days. It 
should not be pushed so far as to operate much on the bowels. 
If the attack can thus be delayed it may probably pass off for the 
time. The great difficulty of managing these cases, arises from 
the indiscretion of persons of this age. They will not abstain 
from excess in eating, nor will they report the symptoms of 
plethora which may come on. 

When the attack has come on, it has been advised, to let the 
blood flow till a reasonable bleeding has, in this way, taken 
place. My opinion is, that this is not a judicious plan. If the 
pulse is very lull in the arteries of the head and neck, after the 
blood has ceased to flow from the nose, a vein in the arm may 
be opened. But this will seldom be necessary; the remedies 
used for suppressing the hemorrhage, will commonly reduce 
the pulse sufficiently. The stopping of the blood is commonly 
a very easy matter. Let the patient place himself, either sit- 
ting or standing, with the head nearly erect. It will be best to 
lean the head against something that it may be still. The face 
should be bent forward, so as to admit of the patient seeing any 
thing on the ground a yard before him. He should then raise 
the arm on the affected side, or both arms at once, if the blood 
flows from both nostrils, and with the fore finger press down 
the out side of the nostril, so as to check, but not entirely stop, 
the blood. The blood will by this means be detained, and co- 
agulate in the nostril ; the upper orifice of which by the posi- 
tion of the head being the highest part. If the arms become 
fatigued, let the nostril be stopped with a roll of lint or cotton 
cloth, inserted loosely so that the blood may at "first ooze by it 
considerably. The clot of blood should be allowed to remain 
till it comes away of itself. I do not know whether I have so 
described this simple process, as to enable any one to practice 
it successfully; but I have met with no case of bleeding at the 
nose in twenty years, which I could not stop in this manner, in 
fifteen minutes. But I must not omit the mention of more 
powerful remedies. If the case is obstinate, let the patient lean 
forward and poUr cold water in a small stream on the head, 
from a pitcher held a foot or more above. The water should 
be as cold as it can be conveniently had, and the process con- 
tinued till the blood ceases to flow, or the patient finds it too 



•586 CANINE MADNESS. 

painful to be borne with convenience. If this fails, take of 
powdered alum, and roll a portion of it in a rag so as to form a 
long tent, containing twenty or thirty grains of the powder. Let 
this be passed as far up the nostril as possible. If this proves 
inconvenient, the alum may be drawn up the nostril like snuff. 
Other astringent powders, especiall galls, may be used in the 
same way. After the snuffing -of such remedies, the position 
and treatment first recommended, should be practiced. In the 
event of these remedies failing, pressure on the part is to be 
tried, if it can be accomplished. The mode advised, is, to pass 
a double cat gut cord through the nostril to the throat, and to 
put in it a roll of cotton or lint and draw it into the nostril next 
the throat. The same nostril, at the end of the nose, should 
be stopped, and the blood cannot escape either way. I am 
told this is a difficult operation ; and I never had occasion to 
practice it. There can be no doubt of its efficacy. I should 
have mentioned another remedy which has often suppressed 
bleeding at the nose. It is the sudden application of a cold 
substance to the parts of the body which are commonly least 
exposed to cold. A large key passed down the back has prov- 
ed a remedy in such cases. A piece of ice passed down the 
body, either on the back or in front, would have still greater 
power. Other ways of making the application of cold to the 
body, will suggest themselves. 

After all, it has been properly suggested, that there are cases 
in which death occurs from the oozing of blood from open ves- 
sels, when the powers of life and the force of the circulation 
are almost extinct. In these cases, the face will be pale, the 
extremities cold, and great faintness, point out the danger of 
immediate death. In such a case, give a tea spoonful of laud- 
anum, and make warm' applications to the extremeties. 



CANINE MADNESS—HYDROPHOBIA. 

. Every one knows that this awful disease is produced in men, 
by the bite of a rabid animal. The animals capable of pro- 
ducing this disorder, are confined to two tribes, the dog and the 
cat, including however their near relatives — the wolf and the 
fox. The wound inflicted by these animals, has at (irst noth- 
ing peculiar in its symptoms : it will heal as readily as any 
similar wound inflicted by any other animal. The time at 
which the disease may make its appearance after the infliction 



CANINE MADNESS. 58 7 

of the wound, is said to vary from nine days, to a whole 
year ; but the time at which it most commonly manifests itself, 
is from four to six weeks after the accident. 

The first symptoms of the approach of this disease, is a pain 
in the wound, or in the cicatrix, if the wound shall have healed. 
This pain extends towards the neck and throat, and frequently 
produces great torpor of the limb affected. This state of things 
may last several days ; but when the attack has fairly come on, 
the symptoms are greatly altered. The state of mind in which 
the patient is found is peculiarly awful : every one who has de- 
scribed it, bears testimony that in no human affliction is the ex- 
pression of countenance, so awful as in this. It can not be be- 
held without the greatest awe, and suffering even to beholders. 
Considerable pain is felt about the region of the heart. A de- 
spair in the mind attends it which admits, of no alleviation, or 
comfort. The patient is perfectly confident of his doom. But 
he is not allowed to suffer in affliction of mind alone : he is tor- 
mented with an insatiable thirst, hiccuping, vomiting of bile, 
and a considerable degree of fever. His sensibility is, in the 
first instance, very much increased, and he is unable to bear 
the touch of his friends, however light. Violent spasms take 
place from time to time, and the mind is frequently thrown into 
the highest degree of delirium. But the characteristic symp- 
tom of the disease, is the inability to swallow fluids which at- 
tends it from the first : if the patient takes water intohis mouth, 
he is seized with a violent convulsion. This S} T mptom is not 
always in this extreme ; but, to some extent I believe it is al- 
ways present. It never has occured to me to witness a case of 
this awful disease in man : I have several times seen it in dogs, 
and other domestic animals. On one occasion where a hog 
had been thrown into this disorder by the bite of a dog, I ob- 
served, on the morning of its attack, an attempt by it to drink 
water : it no sooner touched the fluid with its mouth than it 
raised its head, recoiled for several spaces, and fell back, as if 
in a dying struggle. Death commonly takes place before the 
sixth day ; and so far, it is painful to say, that no remedy has 
been discovered for the disease. 

TREATMENT. 

Although hydrophobia, when it has been fairly established, 
has always proved fatal, the treatment of the bite of a rabid 
animal is by no means a matter of indifference. It is a con- 
ceded fact, that the perfect excision of the tooth marks of the 



588 poisons. 

dog, is to be relied on with great confidence for the prevention 
of the disease. This should therefore be done in every case, 
where the dog which has inflicted the wound is reasonably sup- 
posed to have been in a rabid state. I am not prepared to say 
that no medicine whatever, can be given, with any prospect of 
advantage, during the painful period which must intervene, be- 
fore it is decided whether the attack will take place; but I have 
nothing to offer, and recommend the excision of the part, and the 
application of caustic to the wound thus enlarged. With this 
recommendation therefore it might be as well to terminate this . 
essay. 

It may not be amiss, however, to state, that in the manage- 
ment of these cases, the attendants will be perfectly safe from 
contracting the disease : no contact with the saliva, or injury 
inflicted by biting from these patients, has ever produced the 
disease in another. It is therefore in our power to bestow on 
these unfortunane victims, all the care that humanity requires. 
It is painful to reflect that in times past, a belief in the infec- 
tious character of this disease, gave rise to a system of man- 
agement peculiarly savage and horrible. Such patients were, 
without mercy, thrown on one bed and smothered with an- 
other ! This practice continued through many ages, and 
was not abandoned in all countries, till about the fourteenth 
century. 

While preparing this article for the press, I notice in one of 
the periodical prints, a statement that the newly discovered ar- 
ticle chloroform, has been successfully used in the treatment of 
hydrophobia. Whether this achievement has been performed, 
by this newly invented remedy or not, lam unable at this mo- 
ment to say ; but there is no article whose powers would seem 
to be more suitable to the treatment of this disease, than chloro- 
form. I should not- hesitate, were a case to occur in my prac- 
tice, to give to this new article, a fair and decisive trial. 



POISONS. , 

Any ^substance which being taken into the body, or in any 
manner applied to it, will produce death, is a poison. The 
number and variety of these substances, is manifestly too great 
to be noticed in detail in this place. I shall not even attempt 
a systematic arrangement of the articles which it is my pur- 
pose to mention, but treat of them in such manner, as I think 






poisons. 5S9 

most useful, without any regard to their relation with one an- 
other. It is my purpose to bring to the notice of the reader, 
such substances, as from being frequently met with, may be 
used either by accident or design for the destruction of life, 
and to set down such of the symptoms they will produce, and 
particularly the remedies used for them, as may appear to be 
requisite. The principal mineral substances which have been 
found to act as poisons, are the sulphuric, nitric, and muriatic 
acids; potash, nitrate of silver, corrosive sublimate, arsenic, 
the salts of copper and of lead, and tartar emetic. In addi- 
tion to these, several animal and vegetable substances might 
be mentioned. Of these, the principal are cantharides, or the 
Spanish fly, prussic acid, and opium. This list might be in- 
definitely extended ; but I shall find by the time a reasonable 
notice is taken of these, that I have devoted as much space to 
this subject, as can be allowed it. 

The sulphuric, muriatic, and nitric acids, are poisons of the 
most acrid and powerful kind. They are poisons from their 
destructive effects, but may be taken when sufficiently diluted, 
not only without injury, but in many instances, with great ad- 
vantage. The sulphuric acid, which is regarded as the strong- 
est of the acids, when in a concentrated form, cannot be safely 
taken into the stomach. Even a drachm of it has been known 
to prove fatal ; but in other cases, three, and even six times 
this quantity has been taken without destroying life. In a di- 
luted form it is a common remedy ; but persons should recol- 
lect, that before it is diluted, it is more than ten times stronger 
than the ordinary elixir vitriol. It should therefore be given, 
with a corresponding degree of care. The nitric acid seems 
to be still more fatal thau the sulphuric ; the dose which can 
be safely taken is still less. The muriatic acid seems to be 
less offensive to the stomach, and may be taken in greater 
quantity ; still an ounce of this in a concentrated form has been 
known to produce death. 

The action of these powerful acids on the stomach, is so simi- 
lar, and the remedies for them so much alike, that I consider 
it unnecessary to- treat of them separately. When taken in 
over doses, they produce a violent burning pain at the stomach, 
and sometimes vomiting, in which the acid is thrown back 
from the stomach. If the article is retained, and passes on 
through the bowels, it produces a caustic effect in proportion 
to its quantity ; and in many instances, fatal results have ta- 
ken place from the injury thus done. 

The sudden and dangerous effects produced by the swal- 



590 poisons. 

lowing of either of these articles in • quantity, render it impor- 
tant that a remedy should be always at hand, and taken in- 
stantly. If nothing better can be done, large draughts of tepid 
water, and even cold 'water, should be taken to excite vomiting, 
that the acid may thus be discharged. But there are many 
substances which readily combine with these acids, rendering 
them innocuous or neutral in the stomach. The vegetable and 
mineral alkalies, potash and soda, are, one or the other almost 
always at hand. Either of these may be dissolved in water, 
and taken in sufficient quantity to neutralize the acid. But 
this should be done by the table spoonful at a time, and not 
continued longer than may be necessary. No certain rule can 
be given for the quantity of these articles which should be 
used ; for the quantity of the acid taken being greater, re- 
quires a greater quantity of the neutralizing substances. A 
safer article than these is found in prepared chalk, which may 
be given in sufficient quantity. Any quantity, to the extent of 
an ounce, may be given in cases of this description. Magne- 
sia, either calcined, or in the form of the common carbonate, 
is also a safe and effectual remedy in these cases. As soon as 
the acid is neutralized in the stomach, or otherwise removed 
from it, the disease becomes a mere irritatition from a caustic 
article, and is to be treated on general principles, without any 
reference to the particular substance that has caused it. 

Potash, either in its common or most caustic form, is a poi- 
son which may produce death, if taken into the stomach. No 
time is to be lost in finding a remed} 7 . The safest and most 
convenient of all remedies is common vinegar, which should 
be diluted with water, and drunk freely until the alkali is fully 
neutralized. The diluted sulphuric or muriatic acids will an- 
swer the same purpose. 

Nitrate of silver — lunar caustic, has become a remedy of 
such common use, and is, withal, so sudden and destructive 
in its effects, that a remedy for too great a quantity taken by 
accident or design, should be known to every one. We are 
fortunately in the possession of such a remedy, and it is in the 
house of every one. It is common salt. A solution of com- 
mon salt in water, should be swallowed as soon as possible af- 
ter the nitrate of silver. This will instantly arrest its effects, 
and the patient will be left with no more injury, than the caus- 
tic has produced previous to the taking of his remedy. 

Corrosive subiimate, or bichloride of mercury is an active 
poison. Three grains of this article have been known to de- 
stroy life ; but I have known fifteen grains of it taken by mis- 



poisons. 591 

take tor calomel, gotten rid of without the destruction of life. 
The symptoms which arise from the swallowing of an over 
dose of this article, are violent vomiting, pain in the stomach 
extending to the bowels, and finally producing a strong cathar- 
tic effect. The vomiting which the article is apt of itself to 
produce, should be so far encouraged, as to allow of the dis- 
charge of the contents of the stomach. But very little time 
should be lost in this. The remedy which has the sanction 
of experience, is albumen or the white of eggs. When brought 
in contact with corrosive sublimate, this substance immediate- 
ly combines with it, and renders it innoxious. It should there- 
fore be taken as speedily as possible, after the patient is known 
to have swallowed the poisonous drug. If the white of eggs 
cannot be readily procured, milk may be substituted, or even 
flour rubbed in water will be found a remedy for this terrible 
poison. As soon as a sufficient quantity of either of these ar- 
ticles has been passed into the stomach, all that we can do 
towards the relief of the patient, has been accomplished. The 
ill effects which may have been produced on the stomach, 
must be treated as in other cases of irritation or inflammation, 
as the case may be. 

Arsenic is probably more universally known as a poisonous 
substance, than any thing else : it is therefore important that 
the means of arresting the ill effects of it, should be known* 
The symptoms produced by an overdose of this substance, are 
nausea, vomiting, and -burning pains in the stomach, and if 
death does not happen in a short time, prostration of nervous 
power, paralysis, and other symptoms of the entire destruction 
of the nervous power. Three or four grains of this substance 
are considered a fatal dose ; although some have escaped who 
have taken thirty or even forty grains. For a long time it was 
considered in vain to offer antidotes for arsenic. The sudden- 
ness of its effects, and the destructive power it exerted, were 
considered almost beyond the hope of remedy. Of late, how- 
ever, we are taught to have faith in certain preparations of 
iron that have been found effectual in neutralizing or destroy- 
ing the effects of this poison. The hydrated oxide of iron, has 
been particularly recommended, and is, I have no doubt, en- 
titled to the reputation it has acquired. It is not long since, 
I had an opportunity of testing its effects. I had procured 
about four ounces of this substance from Rushton & Co., New 
York, and kept it closely sealed for two or three years ; when 
suddenly there appeared at my door, a man who informed me 
that he had four little negroes poisoned with arsenic. They 



592 poisons. 

had, an hour before, eaten some cheese, which had been poi- 
soned with this article for rats. They were all four vomiting 
violently, and two of them appeared to be in the greatest ex- 
tremity. The whole of the medicine which I had was instant- 
ly sent to them, and directed to be mixed in about a gill of wa- 
ter, and given them by the table spoonful as fast, as it could be 
administered around, until, they had obtained relief. I was 
not present at the administration, because the patients were at 
some distance from me, and I hurried off the messenger as fast 
as I could. Two of these patients were relieved in less than 
five minutes, and the remaining two in the course of an hour. 
All four recoveied without the slightest ill consequence , and 
even in a day or two were apparently as well as ever. It is 
suggested that other preparations of iron, may be used with 
equal success for the relief of patients poisoned with arsenic. 
The common carbonate, or the precipitated carbonate, which- 
ever can be most easily obtained, should be tried. It is sug- 
gested also, that other absorbent medicines, such as prepared 
chalk, and magnesia, should be tried in the event of nothing 
better being at hand. 

Copper. The salts of this metal are all poisonous. Verdi- 
gris, and blue-stone, the most common preparations, are poi- 
sons if taken into the stomach in too great quantity. The ef- 
fects produced by them, are violent pain in the stomach, nau- 
sea, and vomiting, which if allowed to continue, finally pro- 
duces pains through the alimentary canal with copious dis- 
charges by stool, not unfrequently mixed with blood. The 
most frequent cause of accidental poisoning by copper, is found 
in the use of vessels composed of this metal as cooking uten- 
sils. It is a peculiarity in this metal, that it is not subject to 
be dissolved even in vinegar, when it is in a boiling state ; but 
if articles are allowed to remain in it until it becomes cold, 
there is great danger that a solution will take place, and ren- 
der the contents poisonous. Many cases are mentioned, in 
which persons, who had taken food thus carelessly prepared, 
have been poisoned, and I have had an opportunity of witnes- 
sing one instance, in which many persons were poisoned in 
this way. The symptoms produced by it were such as I 
have described above. Fortunately, no case of death occur- 
red. It is painful to remark, that we have nothing worthy of 
being called a remedy for this accident : no antidote is known, 
and we are left to use such means of diluting the contents of 
the stomach, as it may be in our power to use, and such relief 
as the use of anodines or other narcotics may afford. 



roisoNs. 593 

Lead is another article which is sometimes used to produce 
the effects of a poison. . It is not so caustic and destructive as 
the articles of which we have spoken ; but taken in a large 
quantity, from a drachm to an ounce for instance, even the su- 
gar of lead becomes a dangerous poison. The symptoms it 
produces when used in this way, are those arising from great 
irritation of the stomach, vomiting, pain, &c. But the most 
common manner in which lead becomes a poison, is by the use 
of it in very small quantities for a great length of time. Me- 
chanics who work in this metal, and painters who use it in the 
form of white lead, are subject to attacks of colic, which are 
believed to arise from this metal. Of late, I observe that it is 
stated, that it is only the carbonate of lead which will produce 
these effects ; and this is the state in which the metal is found 
in white lead. How small the quantity is, which will pro- 
duce these effects, cannot be known, and it is even doubtful, 
whether it is absolutely necessary, that it should be taken into 
the stomach ; for the painter, and plumber, in many instances, 
are found attacked with this disease, when there is no evidence 
whatever that they have taken lead into the stomach. When 
poisoning has taken place from the introduction of large quan- 
tities of the salts of lead into the stomach, relief may be ex- 
pected from the use of albumen, or the white of egg, or milk, 
or flour, as recommended in the treatment of poison from 
corrosive sublimate. The colic which arises from the use of 
this metal, has been treated of in this work, under the title of 
painter's colic. 

Several preparations of antimony are fully entitled to be con- 
sidered poisonous ; but they are so little in use, that I think it 
only necessary to speak of tartar emetic. Every one knows 
the violent vomiting produced by tartar emetic, and no further 
description is necessary of the disorders it produces. The 
prostration which attends an overdose, is sometimes produc- 
tive of danger, and death. We have two remedies well wor- 
thy of trial, for the removal of the effects of tartar emetic. The 
first is powdered galls, or what will answer the same purpose, 
a strong infusion of oak bark. A tea spoonful of powdered 
galls, may be put into three or four table spoons of water, di- 
vided into three or four doses, and given, one every five min- 
utes, till the vomiting ceases. Opium, is also a powerful 
remedy for arresting the effect of antimony. It should not be 
given until vomiting has been sufficient to throw off the con- 
tents of the stomach ; then give laudanum in doses from sixty 
to an hundred drops as the case may seem to require. This 
38 



594 poisons. 

remedy should be repeated, from time to time, as long as the 
case may seem to demand it. 

. Cantharides, or Spanish flies, are a fatal poison when taken 
internally in doses which are too large. Twenty-four grains 
is the smallest quantity which I have seen spoken of as hav- 
ing produced death ; but I should think a much smaller quan- 
tity might be productive of this consequence. The symptoms 
which arise from it, are peculiar, and may serve to distinguish 
ii from other poisons. In addition to the pain and vomiting 
usual from irritating poisons, canthar'ides produce stranguary, 
incontinence of urine, bloody urine, and frequently priapism. 
These symptoms will sufficiently distinguish it from any other 
poison. Unfortunately, we are not in the possession of any 
thing which is entitled to the name of a remedy against this 
poison. Copious, diluting, and watery drinks, and in the last 
stage, such use of laudanum as the pain and exhaustion of the 
patient may seem to require, form perhaps the only remedies 
worthy of being mentioned. 

All the articles which we have yet named as poisons, pro- 
duce a violent irritation of the stomach and vomiting, and thus 
produce their own discharge from the body. This gives many 
advantages in the treatment of such cases ; but there are other 
articles equally destructive of life, which produce no vomiting, 
or tendency to their own discharge from the system. I shall 
mention a few only of these. 

Prussic Acid. This article, although a poison so deadly, 
that one may not look on it without fear, has become so com- 
mon in our shops, that it would not seem proper to pass over it 
in silence. The dose of it which may be safely taken, is so 
small, that I will not pretend to particularise it here : all that I 
think it necessary to say, is, that it is instantly destructive of 
life if taken in too large quantity. No substance with which 
we are acquainted, seems to destroy animal life so suddenly. 
Of late, it has been suggested, that the sudden effusion of cold 
water on the body of persons who have swallowed this sub- 
stance, has sometimes appeared to restore them, when life ap- 
peared to be extinct. I should certainly try this remedy if I 
had an occasion for it ; but I confess I should not use it with a 
great deal of confidence. 

Opium. Although this article is one of our most valuable 
remedies, we do not dare to exclude it from the class of poi- 
sons. Taken in large quantities, it is well known to produce 
a sleep so profound as to end in death. The quantity which 
is sufficient to produce this effect, varies from four to twenty 






CACHEXIA. 595 

grains of solid opium. Less than four grains, has, 1 believe* 
never been known to produce death in a grown person ; and no 
individual except habituated to its use, can safely take as much 
as twenty grains. The preparations of opium, most commonly 
used, may properly be mentioned here. Of morphine, a grain 
is as much as can be safely used : from two to four grains is a 
fatal dose. Of laudanum, from sixty to an hundred drops may 
be safely taken : from two to four hundred drops, which will 
nearly fill an ounce vial, will be certainly fatal. The remedies 
which have been used for the relief of persons who have taken 
fatal doses of opium, are principally such as produce its dis- 
charge from the stomach. The most certain emetic for this 
purpose is ipecac, which although a very mild emetic, seems to 
operate with great promptness in the presence of opium or 
laudanum. It should be given promptly, and in large quanti- 
ty : thirty grains, for instance, every five minutes. Should the 
stomach not reject it, means should be instantly adopted to 
evacuate its contents by means of a stomach pump, which I 
need not describe in this place. As to remedies for the cor- 
rection or removal of the effect of opium which is retained in 
the system, they have, one by one, lost their credit, until it is 
now believed that we are not in the possession of a single ar- 
ticle worthy of being mentioned. The only security is to pro- 
duce a thorough and full discharge of the contents of the stom- 
ach, and after this is accomplished, to hinder the patient from 
dropping off to sleep. After a sufficient time has elapsed for 
the effect of the opium to pass off, there can be no doubt but 
much benefit will arise from a moderate use of other stimulants. 
A little brandy and water, or a glass of porter, or a strong cup 
of coffee may be tried. 



CACHEXIA. 

This term has been applied by medical writers to numerous 
diseases, all producing as they say, " a condition in which the 
body is evidently depraved." This state of the system has 
been thought to arise from scrofula, scurvy, rickets, dropsy, 
cancer, and other diseases. But many of these diseases are 
entitled to a separate consideration under their own titles ; and 
the cachexy which belongs to them, will find its proper treat- 
ment in their consideration. I propose, therefore, to consider 
in this place, only a single form of cachexy, which usually arises 



596 CACHEXIA, 

from that depraved health, which grows oat of disorders of the 
spleen, of the liver, and sometimes from the impaired powers 
of the stomach. These cases are commonly witnessed in the 
childhood and youth of persons who have resided in unhealthy 
localities, and been exposed to hardship and privation. That 
region of the South which has been termed sickly, affords the 
principal examples of this disease ; but there it is so frequently 
met with, and so destructive, that I should have thought myself 
unpardonable to have passed it unnoticed. 

CAUSES. 

A depraved appetite is frequently observed as the first symp- 
tom of the approach of this disease. This state of the appetite 
manifests itself in early childhood, and produces a love for chalk, 
clay, common salt, or other equally improper, and indigestible 
substances. This appetite, if unrestrained, or uncorrected by 
proper remedies, leads to the destruction of many children ; 
tor they go on, increasing in the quantity of those improper ar- 
ticles, as long as they live. A similar state of health is some- 
times brought on by the annual recurrence of intermittent fe- 
ver, and in many instances we find patients laboring under the 
same state of disease without being able to attribute it to any 
cause whatever. When the disease has been fairly brought on, 
its most prominent symptom, is a cadaverous paleness of the 
face, even extending to the lips. At the same time the pulse is 
full and round, and by looking on the patient the arteries of the 
neck will be seen beating on each side with great violence : the 
breathing, at the same time, is hard, and there is present a 
great degree of debility. Subdued in spirit by this state of 
health, the sufferer sinks down, and without appearing to de- 
sire even health, gradually declines to the end. This de- 
scription, applies particulary to persons between the ages of 
seven and twenty; but older persons are, many times, affected 
in the same way. Even the depraved appetite which has been 
mentioned, is sometimes so violent in grown persons that they 
give way, like children, and sink under so low a vice, as eat- 
ing dirt. 

TREATMENT. 

In pointing out the remedies for this disease, I feel that it is 
necessary to state that although the patient is reduced, pale and 
emaciated to the last degree, he is very commonly laboring un- 
der an active inflammation of some important organ — the liver, 



CACHEXIA. 597 

or perhaps the spleen. He is therefore incapable of being re- 
lieved by the stimulants and tonics, which would seem to be 
so plainly indicated in his case. He must be treated, in the 
first instance, with certain depleting remedies, and with others 
which have obtained the name of alteratives. Where there is 
present much fever with strong and bounding pulse, I do not 
hesitate to advise the letting of blood : the quantity drawn, 
should, however, not be great. It should be about half the 
measure that would be proper to the same person, in an acute, 
inflammatory disease, such as pleurisy. This remedy, will 
hardly require to be repeated ; but should the same symptoms 
continue after a week or ten days, I should certainly advise, 
that it be repeated. At the time of the first bleeding, give an 
ordinary cathartic of calomel. Take another dose suitable to 
the age of the patient, and divide it into six portions: of this 
give him one daily till the whole is taken. By this means, he 
will be probably, thrown in some degree, into a mercurial hab- 
it : and this is the greatest of our remedies for this disorder. 
But it may not be safe to persist in it farther, and the patient, 
will be very frequently found, but partially relieved. The 
next remedy to be offered is iodine : this should be given in 
the form of tincture, from five to twenty drops, in water, three 
times a day. This may be continued for two weeks, and if the 
symptoms do not appear to give way, it may yet be continued 
for a longer time. In addition to these remedies, where there 
is an evident enlargement of the spleen, a blister should be ap- 
plied over the region of that organ. In some of these cases 
there is a strong tendency to dropsy: and in such instances, 
pills composed of calomel and squills may be substituted for 
the calomel that has been above recommended. Where the 
swelling of the extremities is very great cathartics of cream of 
tartar and jalap, may be given from time, to time, according to 
the urgency of the symptoms. This is a tedious disorder, and 
the remedies spoken of, should not be crowded too rapidly, 
one on another, but time should be allowed that the changes 
which may happen, may manifest themselves in the symptoms. 
As the disease approaches its termination, whether the patient 
be gaining or not, it wiil be necessary to suspend these reme- 
dies, and to resort to tonics and stimulants : preparations of iron 
are the most valuable in this stage of the complaint. The mu- 
riated tincture may be given in doses of from five to twenty 
drops, three times a day. Other preparations of iron may 
substituted from time to time ; but this is to be the leading 
remedy for the restoration of the digestive powers of the pa- 



598 hiccup. 

tient, and the restoration of the red blood of the system. 
Great attention should be bestowed on the diet and drinks of 
these patients. It is to be recoiled that the appetite is wholly 
depraved, and that, in many instances, it is as ravenous as in 
any other disorder. Care should therefore be taken that the 
food which is given, should be of easy digestion, although not 
too deficient in nutritive power. The same care is necessary 
in regard to the use even of water ; for the thirst is sometimes 
as insatiable as the appetite for food : water, therefore, should 
be given with due care that too great a quantity is not taken.. 



HICCUP. 



Every one has seen this mild and safe, though sometimes 
very troublesome and painful disorder. It consists in certain 
spasmodic motions of the stomach, the diaphragm, and oesopha- 
gus ; and learned writers have not been able to decide the ex- 
act character of these motions. When the disorder occurs, it 
produces a sudden, convulsive motion, attended with some de- 
gree of noise in the throat or stomach, and this is repeated 
sometimes every half minute } but at other times not so often. 
The disorder frequently subsides, of itself ; but in other instan- 
ces, even in healthy persons, I have known it to continue for 
days, and even weeks. Sometimes it occurs in the last stage 
of fever, in which case it is considered a sign of the great pros- 
tration and danger of the patient. As to the causes of this dis- 
order, they are equally the subject of dispute. Most frequent- 
ly, I think the attack is brought on b} r the presence of indi- 
gestible food too hastily swallowed. But there are cases. in 
which it appears to be brought on by the want of food. The 
remedies which appear to succeed in arresting this disorder, 
are as inconsistent as its causes. When the disorder has aris- 
en from the want of food, there can be no doubt, but the readi- 
est way to remove it, is the taking of some easily digestible 
aliment. When it arises from the presence of indigestible 
food, which is by far the most common case, it is to be arrest- 
ed by remedies of a different character. Here the use of 
stimulants of various kinds has been advised. Opium, or 
laudanum, in doses of thirty drops, has been often found effec- 
tual ; but I prefer the water of ammonia, or common harts- 
horn in these cases. Twenty or thirty drops taken in water, 
and repeated, if necessary, in half an hour, will seldom fail to 



HEMORRHAGE. 599 

arrest the disease. Making a deep inspiration, and holding 
the breath for as great a length of time as the patient can en- 
dare it, will, sometimes, put a sudden stop to the disorder. 
The distension of the stomach, also, by slowly swallowing a 
large draught of water, as much as the patient can get down, 
will sometimes also, arrest the disease in a moment. 

Considering the disorder as depending on indigestion, it is 
reasonable to suppose, that such tonic remedies, as will give 
strength to the stomach, and enable it afterwards, to digest the 
food taken in it more promptly, will have the best tendency in 
this disorder. I have accordingly ordered them with very 
beneficial results. When the attack of the disorder is sudden, 
it is frequently arrested by any emotion of the mind : surprise, 
fear, or any thing of the kind, will suddenly arrest it. In ad- 
dition to these remedies, such absorbent or alkaline medicines, 
as are usually taken to correct an acid stomach, may be given. 
Calcined magnesia, precipitated chalk, or carbonate of soda, 
given in moderate doses, will answer this purpose. 



HEMORRHAGE. 

A discharge of blood from any part of the body, is termed a 
hemorrhage. The danger attendant on many of these dis- 
eases, is so great, and their occurrence so frequent, that they 
are treated of under separate heads in all treatises on medi- 
cine. But their variety is so great, that it would be beyond 
our limits to give to each a separate consideration, and we 
have contented ourselves with treating of the most important 
under their particular denominations, leaving the subject at 
large, to be treated of in this place. We are not about to treat 
of the flow of blood which attends wounds, or injuries of that 
description, but of those cases which occur spontaneously, and 
often without any assignable cause. These cases are very of- 
ten exceedingly alarming ; and in many instances, fatal. Al- 
most all parts of the body are subject to this disorder : the 
most frequent cases are discharges of blood from the nostrils, 
from the hemorrhoidal vessels in piles, from the uterus in fe- 
males, and from the lungs. But there are cases of hemorrhage 
from other parts. In some instances, blood has been seen to 
flow even frrom the unbroken surface of the skin; and the 
whole internal mucous surface of the alimentary canal is sub- 
ject to this disorder. 



600 HEMORRHAGE. 

The causes of hemorrhage are exceedingly various. It is 
often a habitual disease, continuing to recur, from time to time, 
for many years, with but little injury to the health of the pa- 
tient. These cases most frequently occur in discharges of 
blood from the nose, and in piles. The quantity of blood 
which is discharged in many of these cases, in a given time 
would lead us to expect, that theie were large blood vessels 
ruptured. But this has not been verified by investigation. 
The blood which is thrown up from the stomach, discharged 
from the lungs, or passed by stool, often flows from vessels ex- 
ceedingly small. Even when death has resulted, the anato- 
mist has frequently sought in vain, for ruptured vessels of any 
kind. The blood, although the quantity discharged had been 
so great as to destroy life, had flown from vessels too small to 
be observed even with a microscope. It had, as it is termed, 
been exhaled from the minute vessels of the lungs, or the in- 
testines, as the case might be. Hemorrhage has been divided 
into two varieties, the active, and the passive. In the active, 
ihe circulation previous to the commencement of the discharge, 
is active or violent; in the passive, the contrary pievails, and 
the blood seems to ooze from the part, either from being of ex- 
traordinary thinness, or from the vessels themselves proving 
too weak to retain it. These divisions have been thought of 
importance in practice ; the passive hemorrhage is so rare, 
that it is not to be expected in common cases, but I have wit- 
nessed it in scurvy, and, perhaps, in some other diseases. 

REMEDIES. 

Where hemorrhage is a habitual disease, it is not to be check- 
ed as suddenly, as if it were not so. For instance ; a patient 
is subject to hemorrhage from piles, or from an occasional dis- 
charge of blood from the nostrils*, or even a spitting of blood. 
When the patient is a female, and under a suppression of the 
menses, the physician is not to come in too suddenly with his 
remedies, to arrest the discharge. It is to be allowed to pro- 
gress to such an extent, as may appear safe and advantageous : 
after this, the suppression of the discharge, is to be attempted 
with the same remedies, which will be advised in other cases. 
On a sudden attack of hemorrhage, from whatever source the 
blood may be discharged, the patient should be placed in a 
situation of perfect quietness. Generally, it will be best for 
him, to be placed in a horizontal position ; but where the dis- 
charge of blood is from the nostrils, an erect position is best. 



BLOODY URINE. 601 

In this situation, the free admission of cool air is first to be pro- 
vided for. If the discharge of blood is very considerable, and, 
has not continued for a great length of time, it will be best to 
opeu a vein, and draw blood from the arm in a full stream. 
This frequently brings the case to a €iose at once. When this 
is accomplished, applications of cold water according to cir- 
cumstances may be freely made. The internal remedies 
which have been relied on, are astringents ; the acetate of 
lead in dosos ef four or five grains frequently repeated, being 
considered the most effectual. Powdered galls in doses often 
grains, or of alum in the same dose, may be administered from 
time to time. The swallowing of cold water or of bits of ice, 
has, many times, proven a valuable remedy in this disease. 
These remedies, are to be used from time to time, according 
to the extent of the disease, and the strength of the patient. 
Where there is reason to believe, that the hemorrhage is of the 
passive kind, and that want of vigor of constitution, and 
strength of blood vessels, is the real cause of the disease, opi- 
um will prove the most valuable remedy in our possession. I 
think I have given it in cases of this kind, with very great ad- 
vantage. It may be given in the form of laudanum, or mor- 
phine. Sixty drops of laudanum, or an equivalent dose of 
morphine, may be given. 



BLOODY URINE— HAEMATURIA. 

This disease consists in the discharge of blood from some 
portion of the urinary passages, which include the kidneys, the 
ureters, the bladder, and the urethra. It is discharged, mixed 
with uriae, or in the shape of pure blood. Where the quantity 
of blood is considerable, and the urine of itself, pale or not of a 
very deep color at the time, there is little difficulty in deciding 
on the presence of this disease. But the color of the urine it- 
self, is so various, that we are not always enabled to decide 
this question so readily. Urine is sometimes as limpid as wa- 
ter ; without any admixture of blood, it is in other instances 
very red ; and by the admixture of bile, it becomes in some 
instances, so darkened, as to have the appearance of being al- 
most black. All these shades are met w T ith, without the pres- 
ence of any blood in the urine. Commonly, there will be no 
difficulty in making the decision. The clear, red color of the 
blood gives to the urine such a tinge, that we are not left in 



602 BLOODY URINE. 

any doubt on the subject ; but where the doubts we have above 
suggested present themselves, a little time, and close obser- 
vation will enable us to settle the question. If the urine is al- 
lowed to stand, and there is a deposit of blood on the bottom 
of the vessel, it will be easily detected ; if there is a deposit of 
such color as to leave .us still in doubt, let heat be applied, and 
if the deposit is from blood, it will be hardened and become 
thicker; if from any other substance, it will re-dissolve in urine 
on the application of heat. Where the quantity of blood dis- 
charged, is so great as to be trickling in drops from the ure- 
thra after the discharge of urine, or is discharged almost with- 
out the accompaniment of urine, there is no difficulty whatev- 
er, in deciding the nature of the case. 

The causes of hematuria, are various ; the most frequent 
is the formation of gravel, either in the kidney or in the blad- 
der. By the action of this gravel, either in the ureter, or in 
the passage from the bladder, a rupture of the small vessels of 
the part, frequently takes place, and is attended with the flow 
of more or less blood. But I think that the hemorrhage, from 
this cause, is generally small in quantity ; the more copious 
discharges of blood, which sometimes take place from the uri- 
nary organs, I suspect to depend on other causes ; but these 
causes are as various, as the causes of hemorrhage in general. 

REMEDIES. 

The acetate of lead has more credit for the suppression of 
internal hemorrhage, than any other remedy. It has accord- 
ingly, been given very extensively in this disease. Four or 
five grains of this article, may be given three or four times a 
day, if necessary ; but there is reason to believe, that a prefer- 
ence is justly due to tannin, or a concentrated decoction of oak 
bark, in this disease. If the tannin is at hand, it may be given 
in doses of from half a grain to a grain, several times, a day. 
If the decoction of oak. bark is to be used, it is not very mate- 
rial what kind of oak is used, the decoction should be made 
strong, and used in doses of about a table spoonful. These 
remedies have proven very efficacious in these disorders, and 
the reason given for it by chemists, is, that this article passes 
into the blood, unchanged, and thus finds its way through the 
kidneys, into the passages, through which the urine is dis- 
charged ; its application to the bleeding surface is, therefore, 
perfect. There are some cases in which the flow of blood in- 
to the bladder is very copious ; and instances have been known 



QUINSY. 603 

of its becoming coagulated, so firmly as to render its discharge 
by the patient impossible. This coagulum is removed by the 
introduction of a catheter, and forcing through it, jets of wa- 
ter, till the coagulum. is broken down, and thus placed in a 
situation, that it may be discharged. This operation will, of 
course, require the hand of an experienced surgeon. 

The gravel, and other diseases which have been suggested 
as the ordinary causes of bloody urine, need not be treated of 
here. They have been discussed under their proper heads. 



INFLAMMATION OF THE THROAT, QUINSY— CY- 

NANCHE. 

The importance of the diseases of the throat, has given rise 
to a classificatiou of them, which would, if followed, lead us 
into details more extensive than useful, and altogether beyond 
our limits. We shall therefore content ourselves with a short 
and practical essay, which may serve to direct to proper reme- 
dies in the cases most frequently met with. 

Every organ connected with the throat is subject to inflam- 
mation, which tends in some instances, to ulceration ; in oth- 
ers, to suppuration ; and in others, to gangreene. These dis- 
orders have borne the common name of quinsy ; but this term 
is not applicable to any particular variety. They sometimes 
arise from exposure to cold or other common causes of inflam- 
mation ; but they are more frequently epidemic, prevailing 
generally from some unknown cause, without any regard to the 
sensible qualities of the air. And it is worthy of remark, that 
when the disease becomes thus general, it assumes a common 
form, each case seeming to attack the same organs, and to pro- 
duce the same character of disease ; whether it be a mild in- 
flammation or a gangrenous sore throat. I shall mention only 
three varieties of this disease. 

1. The most common form of this disease, is an inflamma- 
tion of the pharynx or common sore throat. It comes on with 
a slight degree of fever, with chilliness on exposure to the cool 
air ; and a soreness of the throat, which renders swallowing 
painful. If the parts become much swollen, fluids are swal- 
lowed with difficulty, or returned by the nostrils, when an at- 
tempt is made to swallow them. On looking into the throat, 
the soft palate and parts adjacent to it, will be found reddened 
and swollen, in proportion to the extent of the disorder. This 



604 QUINSY. 

form of the disease usually terminates in four or five days, 
without producing worse symptoms. 

REMEDIES. 

If the fever is considerable, and the difficulty of swallowing 
great, and especially if the patient is subject to frequent attacks 
of the disease, an emetic should be given without delay. If the 
case is at all serious, tartar emetic or antimonial mixture should 
be preferred. A prompt emetic operation should be brought 
on. After this, astringent gargles may be used, two or three 
times a day. A decoction of red oak bark, or sage tea, with a 
small portion of alum in it, will answer every purpose. Few 
cases of this disorder, will require any further treatment. 

2. A more violent inflammation takes place in other cases. 
The disease involves not only the lining membrane, but the 
substance of the soft palate and tissue surrounding the throat. 
This inflammation tends to suppuration ; it is a serious dis- 
ease when it attacks principally the soft palate or back part- 
of the throat, where it often produces suppuration. When it 
attacks the sides of the throat, between and below the angles 
of the jaws, it is still more alarming ; frequently causing suf- 
focation and death in a short time. In the worst cases, there 
is no hope except from an operation to open an orifice in the 
wind-pipe, through which breathing may be carried on, till the 
swelling subsides. I have never, except once, found it neces- 
sary, to resort to this remedy. The swelling of the throat ren- 
ders the operation difficult, and a good surgeon should be call- 
ed to the task. When the disease is less violent, and admits 
of more moderate treatment, suppuration sometimes takes 
place, and admits of an external opening for the discharge of 
the matter. 

TREATMENT. 

This form of quinsy is to be treated as a common inflamma- 
tion. Bloodletting should be resorted to, early ; and if the pa- 
tient can swallow, give an emetic of antimonial mixture. This 
should be followed by a full dose of calomel. Cold applica- 
tions should, at the same time, be made to the throat. These 
remedies should be promptly and vigorously used, till the swel- 
ling ceases to increase ; after which, time must be allowed 
for the disease to subside, or for the suppuration to take place, 
if it has not been prevented. 

3. The third variety of this disease is attended with ulcera- 



QUINSY. 605 

tion, and sometimes gangrene of the throat. This form of 
quinsy, has been termed putrid, malignant, gangrenous, and 
I know not what else ; but it matters little what it is called. 
The disease makes its appearance with fever, attended with 
great prostration of strength, rapid pulse, and great swelling, 
and soreness of the inner surface of the throat. In a day or 
two, the breath becomes exceedingly offensive ; and on exami- 
ning the throat, it will be found already extensively ulcerated. 
Sometimes there will be spots of mortified flesh not yet thrown 
off; but commonly the ulcers will be deep, ragged, and foul, 
in a high degree. The countenance of the patient is haggard, 
the extremities cool ; and sometimes, the circulation in the 
skin, so languid, that the whole surface will have a tawny 
color, and a spot on which pressure is made, will remain white 
for a minute or more, before the blood will again fill the veins 
and restore its color. These symptoms belong to diseases of 
malignity and danger ; and these cases are frequently fatal. 
These symptoms so closely resemble certain cases of scarlet 
fever, that I should not always be certain whether they had 
not arisen from that disease. The treatment of the two dis- 
eases is the same. 

REMEDIES. 

If any disease requires the presence of an experienced phy- 
sician, it is this. The treatment is by no means agreed on ; 
and when the disease comes on with malignant symptoms, 
there is but little hope. If called on the first or second day, 
and the prostration of strength is not very great, I advise a 
prompt dose of tartar emetic. This having operated, give 
two grains of opium with ten grains of calomel ; and apply a 
blister to the back of the neck. If the pulse is strong, and not 
very rapid, and the countenance florid, the opium should be 
omitted ; and if the calomel does not operate in four or five 
hours, give a moderate dose of castor oil. Few cases of this 
disease, will admit of the further use of evacuating remedies 
of any kind. It may be safely concluded, that after the third 
day, the patient will require all the support which can be giv- 
en him. The remedies I have used, are principally opium 
and quinine. Three grains of opium and ten or fifteen grains 
of quiuine, divided into six doses, may be given in the course 
of twenty- four hours. To this may be added brandy and wa- 
ter, according to the degree of prostration which may be pres- 
ent. v A diet as rich and nutritious as the appetite of the pa- 
tient will receive, will also be proper. 



606 INCONTINENCE OF URrNE. 

The local treatment of the ulcers iu the throat is simple, but 
important. Many astringent gargles have been reccommen- 
ded; but the decoction of oak bark, or sage tea, with alum dis- 
solved in it, are as good as any other. The use of these should 
not hinder the application of stronger styptics to the ulcers. 
Undiluted muriatic acid applied with a small mop, or camel 
hair-pencil, has been highly spoken of. I prefer, however, the 
application of lunar caustic in substance. This is easily done 
where the^ ulcers can be readily seen. But a strong solution 
of this article, in water, thirty grains to the ounce, may be 
used with a pencil, as above directed for the muriatic acid. 
This application may be repeated daily, till the dark and rag- 
ged appearance of the ulcers passes off; and they assume a red 
color. 



INCONTINENCE OF URINE— ENURESIS. 

It is the office of the bladder to retain the urine for a time* 
so that its discharge may be effected at a convenient moment. 
When this discharge is involuntary, it constitutes incontinence of 
urine. This disorder is of various degrees of intensity. In its 
mildest form, the urine is discharged during sleep ; but can be 
controlled by the voluntary powers when the person is awake. 
This is common in childhood, and not a subject of any uneasi- 
ness, unless it occurs in children of four or five years old. A 
stronger case of this disorder is marked by the ability of the 
patient to retain his urine only for a very short time, when the 
small quantity which may have accumulated, flows involuntari- 
ly, if not allowed to pass willingly. A still worse case, is that 
which allows of no detention of urine in the bladder ; the fluid 
passing off, drop by drop, as it is formed. 

The resemblance of urine to water, makes it rather hard for 
us to conceive of its offensive and excrementitious character. 
When retained about the person, it soon produces a putrid and 
ammoniacal smell, which is in a high degree offensive ; and any 
part of the body kept moist with it soon becomes ulcerated and 
painful. He is, therefore, truly unfortunate, who is the victim 
of such an infirmity. 

Incontinence of urine may arise from a great variety of 
causes. The worst cases are brought on by injuries to the 
bladder and urethra, from wounds or surgical operations. The 
milder cases are those attended with a flow of urine during 
sleep. These are common in childhood, but sometimes ex- 
tend to youth and even maturity. They are often the re- 



WHITE SWELLING. 607 

suit of the neglect of mothers and nurses, who take no pains to 
hinder children from going to bed without discharging the urine 
which may have accumulated ; and thus almost force them to 
discharge it while they are in a profound sleep. The habit of 
childhood, which is thus formed, is confirmed in those who are 
not easily aroused from sleep, and I have seen such cases ex- 
ceedingly annoying in youth. 

REMEDIES. 

When the patient is wholly unable to control the discharge, 
from weakness or torpor of the urethra, remedies should be 
used to excite, the part. Blisters on the loins, or on the inner 
parts of the thighs, are worthy of a trial. The internal use of 
tincture of Spanish flies, may be made in small doses for sev- 
eral days, till a heat and burning pain is felt from the passage 
of the urine. I have given spirit of turpentine, in doses often 
drops, three or four times a day, with as much benefit. There 
are cases in which all remedies are of no avail ; and the pa- 
tient is left to choose some one of the many contrivances which 
have been made to dispose of the urine, in the least offensive 
way. The cases which occur in children, and affect them 
only in sleep, are seldom beyond the hope of benefit from prop- 
er remedies. The first rule to make with such children is to 
be sure that they evacuate the bladder immediately before go- 
ing to sleep. If this does not answer, let them be aroused and 
caused to mako the necessary evacuation before it happens of 
itself. This. should be done in a manner to arouse their sensa- 
tions to perfect wakefulness ; for there are cases in which a 
profound sleep is more in fault than any thing else. A perse- 
verance in such management will often succeed better than 
remedies of a different kind. We are charged against using 
remedies in these cases which increase the flow of urine. This 
rule has its exceptions. I have given a few drops of spirit of 
turpentine, at bed time, with manifest advantage ; and I have 
used tincture of Spanish flies in the same way. I have no 
doubt that the acrid urine produced by these remedies, tends 
greatly to arouse such patients to the duty of rising to discharge 
the urine which they might otherwise pass in bed. 



WHITE SWELLING. 

The term white swelling is in the mouth of every one, but 
if I am asked what disease is signified by this title, I shall 



608 WHITE SWELLING. 

not find a ready answer. The swellings which I shall describe 
under this title arise from the diseases of the bones or carti- 

la g e ?' 

The white swelling which I have most frequently met with, 

attacks and destroys the solid bone, as gangreene destroys the 
softer parts. It is most common in the tibia or shin bone, 
which it sometimes destroys in its whole length but never ex- 
tends to the joints. It also attacks other bones, and I do not 
know that any bone is positively exempt from it. The disease 
in its commencement is very painful, attended with fever and 
swelling of the part but without the redness which attends a 
common inflammation. The leg when thus affected is swollen 
in its whole length, and has a shining white appearance which 
has given to the disorder its name. The inflammation and le- 
ver continue for three or four weeks, when a copious suppura- 
tion will be found to have taken place. The matter will lie 
near the bone and when it is discharged the bone if examined 
with a probe will be found exposed and bare. A tedious pro- 
cess of exfoliation separates the dead bone, and after it is re- 
moved the place is supplied in a wonderful manner with a new 
bone, which is a good substitute for the old. Thus terminates 
this variety of white sweiling. 

The next variety of white swelling attacks the joints or rather 
the ends of the bones of the great joints. It seems not to at- 
tack the smooth surfaces or cartilages of these joints. A slight 
enlargement and' moderate pain in the joints will be first noti- 
ced. By degrees the pain grows worse, the bone enlarges and 
the joint become stiff. This stiffness is not from adhesion of 
the bones, but from mere distension of the part. Ill health and 
great lameness attend it, but no exfoliation or suppuration 
takes place and the patient is sometimes left for life with great 
lameness and deformity. The skin over this swelling is of 
its natural color. 

A third variety of white swelling attacks the cartilages of the 
joints. This in the outset resembles rheumatism, but the pain 
is less intense. After many weeks the cavhy of the joint af- 
fected is filled with matter which bursts forth, if it is not punc- 
tured, and discharges a large quantity of glairy matter mixed 
with pus. I have seen a boy of twelve years old, with both 
wrists, and both ankles, discharging largely from this disease 
at the same time. This disease may continue for a great length 
of time. In its ordinary course it admits of relief, only by an 
anchylosis or growing together of the bones, producing a stiff 
'oint. 



WHITE SWELLING. 609 



These diseases have a strong resemblance in the slowness 
of their progress and the difficulty of their cure. They pro- 
duce the same pale and cadaverous hue, and the health of the 
sufferer is much the same. They are commonly thought to 
arise from scrofula, but I am not prepared to support the 
opinion. 

TREATMENT. 

The treatment which is proper in each of these varieties of 
white swelling is very much the same. The disease in the 
outset is inflammatory, and requires active remedies. A ca- 
thartic of calomel, followed if necessary with castor oil, should 
be first given. If the fever continues, give antimonial mixture 
three or four times a day in such doses as the stomach will bear 
without producing vomiting. Continue this according to cir- 
cumstances, but do not push it too far, as it is not probable 
that the disease can be stopped short of its destructive work 
on the bones or joints. The strength of the patient must there- 
fore be preserved, that he may sustain himself well in a tedi- 
ous complaint. If the case ends in suppuration the depleting 
remedies should be suspended, and openings made for the dis- 
cbarge of the matter. If the swelling continues without any 
discharge of matter the patient at last becomes exhausted and 
requires remedies of a tonic and supporting kind. 

There is then in all cases of white swelling a second stage, 
in which every means of support should be extended to the 
patient. A generous diet should be allowed and a portion of 
brandy given at meals. This should be in small quantity 
at first, but may be increased to a table spoonful twice a day 
if it does not cause a manifest rise of fever. If great exhaus- 
tion comes on, from ten to twenty drops of muriated tincture of 
iron may be given twice a day. Tincture of gentian or other 
vegetable bitters may also be tried. The tedious nature of the 
disease will give ample time for the trial of these remedies. 
The time at length arrives, when the case must be turned over 
to the surgeon. When the disease of the joints threatens life, 
from the excessive discharges it gives rise to, the amputation of 
the limb becomes necessary. In other cases large portions of 
bone become detached and require extraction. These opera- 
tions require skill, judgment and experience. 



39 



610 GOITRE. 

GOITRE— BRONCHOCELE. 

This is a disease of the thyroid gland — a body of considera- 
ble size extending across the throat, the uses of which are un- 
known. The disorder in question is a chronic enlargement of 
this gland — sometimes continuing from youth to age, without 
producing any dangerous symptoms. In other instances, how- 
ever, the enlargement becomes so great, that its pressure on 
the adjoining organs is felt with great inconvenience, and it has 
at times produced death. I have witnessed one case of death 
from the pressure of this enlargement, on the trachea. In an- 
other instance I have found it produce death in an old lady 
who had had it from her youth ; but at last an inflammation 
took place which ended in mortification ; and, after the slough- 
ing out of almost the whole gland, she expired. 

The causes of this disease are involved in great obscurity. 
In this country, it must be considered a rare disorder ; but in 
certain mountainous countries, Switzeland and some others, 
the disease is common. But the investigation which has been 
extended to this subject has not enabled us to assign the rea- 
sons of its prevailing in one country more than another. Its 
attacks are principally made on the female sex. I do not re- 
collect to have ever seen it on a man. In countries in which 
it prevails as an endemic disease, it produces, in some instan- 
ces, a remarkable change in the powers of the body and the 
mind. Persons thus affected are said to be attacked with cre- 
tinism ; and this disorder appears to be capable of being 
piopagated from one generation to another. Cretinism has 
never been known to appear in this country. It produces al- 
most an entire destruction of the mental powers. 

DESCRIPTION. 

Goitre usually makes its appearance by a very gradual en- 
largement of the thyroid gland, sometimes on one side only ; 
but, more commonly, both sides are affected at the same time. 
The tumor is soft and flab by, producingneither pain nor unea- 
siness ; but from its growth, soon becomes a matter of atten- 
tion and uneasiness to the patient. When left to take its own 
course, its growth is usually continuous ; and so large does it 
become, that, in many instances, it fills the whole throat, so 
that the chin rests on the tumour. More commonly, however, 
the enlargement is greatest at the sides, and the chin is left 
free in its movements. This enlargement becomes inconveni- 
ent from its size ; but the health of the patient, although it sel- 



GOITRE. 611 

dom appears to be robust, is not destroyed. In this state, the 
progress of the disease may continue for an entire lifetime. 
The swelling is, however, subject to attacks of inflammation ; 
and, as I have mentioned above, I have known one instance in 
which this inflammation ended in mortification and death. 

TREATMENT. 

I will not detain the reader with an account of the various 
modes of treatment which have been adopted in this disease. 
It is conceded that it is not a fit subject of surgical operations. 
Two medicines alone have seemed to operate as curatives of 
this disease; and these, as chemistry has, of late, decided, both 
contain the same element. The first of these remedies is 
sponge, which physicians were in the habit of partially burn- 
ing or charring, so that it could be reduced to powder, and 
given in doses of ten grains, two or three times a day. This 
remedy has, unquestionably, produced cures, in many cases, 
of goitre. Iodine is the next remedy entitled to notice in this 
place. This remedy exerts a manifest and absolute power 
over goitre. Applied externally, or taken internally, the dis- 
ease in almost every instance gives way and is cured. In my 
own hands it has almost always produced the removal of the 
disease in a short time ; and so superior is it, to all other reme- 
dies which have been discovered, that no other remedy is 
thought of in ordinary cases of goitre. The preparation which 
I have used is a tincture of iodine made by dissolving forty 
grains of this substance in an ounce of alcohol. If the alco- 
hol is not good, the solution will be imperfect and have the ap- 
pearance of being muddy. In this event the quantity of the 
alcohol should be doubled, and the dose given also double. 
The dose of the tincture I have recommended, is from ten to 
twenty drops, in water, twice a day. This dose is almost as 
much as can be very safely advised. Sometimes it produces 
tremors, sneezing, giddiness and other nervous symptoms, 
which require that it should be laid aside for a time or the dose 
lessened. In either event it should be continued until the 
whole ounce is taken, by which time probably the swelling will 
be very much reduced or entirely gone. After this quantity is 
taken the patient should pass some time without the use of the 
remedy ; for it is one of those articles which is said to produce 
alarming nervous disorders, when too long continued at one 
time. In my hands, however, it has proved entirely safe and 
manageable. Another preparation of iodine has it advocates ; 
and I am disposed to think it fully as good, if not better than 



612 DISEASES OF SENSATION. 

the one I have recommended. This is the hydro-iodate of 
potash. Take of this substance sixty grains, and dissolve it in 
two ounces of water. The dose of this solution will be from 
ten to twenty drops, and should be regularly given under the 
same regulation and advice with the tincture above recom- 
mended. The local application of this remedy has been very 
beneficial in my hands. Where the tumor is large, and has 
been of long standing, I have been in the habit of having the 
same tincture applied over the tumour at the same time that it 
is given internally. A feather dipped into the solution and 
passed rapidly over the surface until it is brought to a deep 
brown color, is the mode in which 1 have been in the habit of 
applying it. The application is to be continued only for a 
minute or two ; for it will speedily cause blistering, and a de- 
struction of the surface if continued longer. But should it 
produce blistering, no uneasiness need be felt; for the blister 
will heal with great readiness, without requiring any dressing. 
If the pain produced by the application I have advised, is very 
great, and the patient is apprehensive that its effects may be 
too great, the application of starch, or any poultice of flour 
will speedily destroy the effect of the iodine. And here let me 
observe of this remedy, that starch is the great test of its pres- 
ence ; for it combines with it so rapidly that every care must 
be taken that it is not allowed to come in contact with it even 
in the stomach. The doses which have been recommended, 
should therefore be taken mid way between the taking of meals, 
when there is every reason to believe that the stomach contains 
no undigested food, and that there will be time for its absorp- 
tion from the stomach before food is again taken. I will add 
that medicine has made few triumphs equal to the discovery of 
a remedy for goitre. So certain and powerful is this remedy 
for the removal of this disease, that it is, every way, entitled 
to be considered a specific ; and it is on facts like these, that 
we found the rational hope that the most painful and destruc- 
tive disorders now affecting the human race have, in nature, 
their antidotes and their remedies ; and that science will, in 
time, bring them forth. 



DISEASES OF SENSATION. 

EXCESSIVE SENSIBILITY HYPE RAES THE SIS. 

SLEEP WALKING SOMNAMBULISM. 

MESMERISM ANIMAL MAGNETISM. 

The very mention of these subjects will excite against the 



EXCESSIVE SENSIBILITY. 613 

author a strong prejudice ; and this prejudice, I apprehend, 
will be found in the highest quarters of medical authority and 
literature. I would willingly have avoided the theme, but ac- 
cident has placed under my observation certain facts, which I 
do not feel at liberty to withhold. Somnambulism, or sleep- 
walking, has long been known as a disorder ; but I think I am 
not mistaken in the opinion, that the most talented medical wri- 
ters have rather chosen to avoid,- than to attempt its elucida- 
tion. The experiments of Mesmer opened a new field of in- 
vestigation, which all will allow has a close connection with 
this subject. I need not mention the manner in which he was 
put down in his day ; but some of the facts which were brought 
forth by these experiments, have remained, as it were, a seed 
of investigation, which has vegetated and flourished in our day. 
There is no longer a doubt of the existence of some of the 
powers that were claimed by Mesmer. But to what extent 
they exist, or are capable of being carried, time alone will in- 
form us. Some of these facts have presented themselves to 
me, in a way which is so connected with several diseases I 
have met with, that I feel bound to present them in that con- 
nection. Of one of these disorders, which I have character- 
ized as an excess of sensibility, I have seen no account in medi- 
cal writers ; I shall therefore attempt an account of it, as it has 
presented itself to me. But I am far from desiring to attempt 
an investigation of these obscure subjects, I shall present facts 
which I have seen, and content myself with the shortest ac- 
count I can give of them. These disorders are attended with 
an altered state of sensibility, involving both body and mind in 
some of the strangest phenomena which have been witnessed. 
I shall treat of them in the order in which I have set them 
down. 

EXCESSIVE SENSIBILITY HYPERAESTHESIS. 

I have said that this disease has not, so far as I know, been 
described by medical writers. It is true we meet with ac- 
counts of excessive sensibility; but the disease, of which I 
have undertaken to give an account, presents a sensibility al- 
together novel in its character — a sensibility, in which contact 
is not necessary to produce sensation. I shall find it easier to 
make myself understood, by giving the symptoms of several 
cases which have occurred, in my practice. I shall not detail 
them separately, for the resemblance of one to another has been 
so close, that I think it wholly unnecessary. 

I may premise, that the subjects of the three cases of this 



614 EXCESSIVE SENSIBILITY. 

disorder which I have witnessed, were females in the prime of 
life ; but neither of them has ever had, so far as I know, any 
hysterical disorder. The disease I am now to describe be- 
gan with alight degree of fever — attended with headache, cold 
extremities, small feeble pulse, and a determination to lie cov- 
ered in bed. The tongue was white in the centre, but red on 
the edges, as in some cases of t}^phus. A disinclination to sub- 
mit to examination by the touch was evident from the begin- 
ning of the attack. The hand which was offered,that the pulse 
might be felt, was withdrawn as soon as possible ; and it was 
evident from the agitation, constraint, and hurried breathing, 
that this was a painful operation. 

Jn a day or two, these investigations became difficult or im- 
practicable. The patient would no longer yield her hand, that 
the pulse might be felt ; but would hide under the bed clothes, 
and retire as far as possible. But after a moment's reflection, 
she would make the strongest efforts to submit to the necessary 
examination. She would voluntarily offer her hand, but if the 
disorder at the time was considerable, she seemed incapable 
of allowing it to be touched. I have seen a quarter of an hour 
consumed in violent struggles by the patient, to lay hold of the 
physician's hand. This she would at last accomplish, with 
such an effort as might be made to sieze an angry serpent ; 
and when it was accomplished, the hand would be held with 
as deadly a grip. This seemed to afford some relief, and to 
render further investigation more practicable for the time. 
s In the course of a week, the sensibility of these patients, be- 
came so disordered, that examinations by the touch were im- 
practicable. They could not bear the wrist to be taken hold 
of, or allow the hand of any person to be brought in contact 
with their fingers' ends, the pit of the stomach or the back, es- 
pecially about the lowest ribs. The shock which would be 
produced by the physician's applying the fingers of one hand 
to the pit of the stomach, and at the same time the other to the 
spine, can hardly be conceived. From every appearance, it 
produced more pain and alarm, than the thrust of two daggers 
into the same parts. The most violent convulsions were sev- 
eral times brought on by such experiments. This extreme sen- 
sibility seemed to be confined to the epigastrium and spine ; 
but no very great excess of sensibility extended to other parts 
of the body ; and the hands were at times scarcely less sensi- 
tive, than the parts I have mentioned. 

At an early period of these investigations, I discovered that 
these violent sensations were capable of being excited, without 



EXCESSIVE SENSIBILITY. 615 

actual touch, or contact with the patient. This 1 had previ- 
ously witnessed in tetanus, where I had seen violent convul- 
sion excited, by the noise of pouring water, or the motion of a 
fan before the face of the patient. But these consequences I 
then attributed to the excited fears of the patient in a situation 
so horrible. In the cases now under consideration, a broader 
field of investigation was opened. The approach of the hand 
of the physician to the epigastrium or spine, was felt at a dis- 
tance of two feet or more. She would perceive it, and, as it 
approached, recoil, or spring: from it with horror. It mattered 
not whether the hand was seen, or the patient knew it was 
about to approach. The profoundest sleep did not hinder the. 
effect. I have tried every device, to approach unseen and un- 
known; but the patient would never fail to detect it, the mo- 
ment I came within two or three feet. Others, in my absence, 
made the same experiments, with the same results. Other 
substances besides the hand, could be brought in contact with 
these parts, before the shock was produced; but when the dis- 
ease was at its height, the slightest touch, even with a feather, 
or bit of muslin, produced the shock. 

I made many experiments to test the character of the pain 
felt from these slight touches or approaches. On placing my 
hands together, and approaching the epigastrium with my fin- 
gers, the patient would feel suddenly a rush, as of steam or 
heat. As I came near, this sensation became strong and in- 
supportable ; and she would attempt to fly in great consterna- 
tion. Neither of them could give any farther or better account 
of the pain. 

Dejection and deep melancholy pervaded the minds of these 
patients. They were, however, quiet, and never became con- 
vulsed, except when excited by some touch or approach from 
others. These convulsions were commonly partial ; but in a 
few instances, general, like epilepsy. In one instance the pow- 
ers of life seemed to be actually extinct ; but, after a few min- 
utes, returned. When the disease was very strong, the patient 
could not bear her own hand near the pit of her stomach ; but 
would lie on her back with arms extended. 

The shocks and excitement, produced by the touch in these 
cases, resembled the operation of electricity ; but the effect of 
thunder and lightning was awful to these sufferers. It was 
witnessed in two only, the third case having occurred in win- 
ter. I had several opportunities of witnessing the effects of 
thunder, on one of these patients, who was a house servant, 
and lived near me. In her, the low sound of distant thunder, 



616 EXCESSIVE SENSIBILITY. 

excited the greatest fear. As the cloud approached, she would 
run under the bed, and wrap her head in a blanket. In sev- 
eral instances, she had made good her retreat before any one 
else discovered the lightning, or heard the thunder. In the 
other case, it happened that several violent thunder storms oc- 
curred while she was at the worst. The approach of these 
clouds seemed to aggravate her disease. She could not bear 
the approach of any one, and hid herself in bed. When a vio- 
lent peal of thunder happened, she would spring up and at- 
tempt to fly. Not daring to come in contact with those who 
opposed her escape, she would spring on the bed, and there 
stand, with outstreched arms, and eyes rolling, as the vivid 
lightnings flashed, and the pealing thunder rolled. No pen can 
describe the terrible sublimity of her gestures, or the horror 
which was depicted in her countenance. The scene was only 
ended with the cessation of the lightning. She would, then 
resume her place in bed ; but with no improvement in her 
symptoms. 

There was, during the whole progress of these diseases, 
more or less fever. It varied in degree, at different times, but 
could not be said to be in paroxysms. It appeared to rise to a 
certain height, where, for a time, it remained ; and then gradu- 
ally declined to its termination. The duration of these cases, 
was from six weeks to three months. The recoveries were 
gradual ; but they have all recovered. 

TREATMENT. 

It cannot be expected that with so little experience, I can of- 
fer, with any confidence, a plan of treatment in this disease. 
I have witnessed but three examples of it ; but as these cases 
have all terminated favorably, it may not be improper, that I 
should give an account of the remedies which I used. In the 
commencement, I administered full doses of calomel, which 
were followed by Seidlitz powders or castor oil. This seemed 
to produce no beneficial effect ; the next day, the symptoms 
were rather worse, than better. The antimonial mixture was 
now given, to operate as an emetic, and continued, in small 
doses, so as to produce nausea, for two or three days, No sen- 
sible benefit was derived from these remedies ; the fever con- 
tinued, and the diseased sensation was rather worse, than bet- 
ter. Anodynes were next resorted to ; and these produced ef- 
fects more satisfactory. Ffteen grains of Dover's powder, 
given once in twelve hours, gave considerable relief. This 



SLEEP WALKING. 617 

remedy afforded very great relief for a time ; but it was found 
necessary to repeat it, after the lapse of ten or twelve hours. 
This and other anodynes, used in a similar manner, constituted 
the whole treatment which appeared to me beneficial, in two 
out of these three cases. But the third presented symptoms a 
little different ; and was treated with some better success. In 
this case, the disease had something like a daily paroxysm, 
which came on with some regularity, producing a sudden and 
violent aggravation of the symptoms. These paroxysms were 
resisted by the use of quinine, given in combination with mor- 
phine or laudanum. Four hours before the expected parox- 
ysm, fifteen grains of quinine were divided into four doses, 
and one given hourly, with from ten to fifteen drops of lauda- 
num, till all were taken. This did not arrest the paroxysm, as 
it would have done in ordinary chill and fever. But its ef- 
fects were obviously beneficial ; the course was persevered in, 
and the case terminated in a manner more satisfactory, than 
either of the others. Several attempts were made, to intro- 
duce quinine into the treatment of those cases, which occured 
without the occurrence of paroxysms. I perceived no benefit 
from this remedy, and therefore abandoned it. I ought per- 
haps to state, that a fair trial was made with oil of amber, 
tincture of castor, assafoetida, and other remedies which are 
usually beneficial in hysterical disorders. They appeared to 
be of no benefit whatever. I therefore fell back on the prepa- 
rations of opium, which gave manifest relief, and I think were 
of very great service. 

SLEEP WALKINGS-SOMNAMBULISM. 

The disorder which has obtained the name of somnumbu- 
lism, resembles any thing as much as sleep. It is true the 
eyes are closed, or not used for the purposes of vision ; but the 
mind is always active ; and, during the time the disorder lasts, 
appears to be much excited. Although the eyes are not used 
for the purposes of vision, there are, somehow, supplied to the 
patient, the perceptions which vision can afford ; and under 
circumstances so strange and unaccountable, that they have 
been a subject of wonder to the learned, for many ages. I 
have not undertaken to write an essay on this subject; but 
barely to introduce a case which has occurred under my own 
observation — an account of which will explain most of the phe- 
nomena which have been witnessed in this strange disorder. 

Mary Rogers, a healthy child, ten years of age, was, on the 



618 SLEEP WALKING. 

30th of May, 1S48, attacked with sleep walking. About ten 
o'clock P. M., while asleep, she was noticed to be much dis- 
turbed. After making some noise, she arose from bed, with 
closed eyes ; but returned, as if determined to remain. In a 
few minutes, she arose in great anger ; and seemed to hold 
conversation with several persons who were absent. She 
soon became restless, active, and noisy, singing and dancing 
with great glee ; and seeming to know the position of every 
thing around her, although her eyes were closed. After an 
hour or two, she was induced to take laudanum ; and, at three 
o'clock, fell into a natural sleep, from which at nine o'clock the 
next morning, she awoke wholly unconscious of what had hap- 
pened. This attack was witnessed by her near friends, par- 
ticularly her aunt and uncle, in whose house she resided. 

Symptoms of the" same disorder were obvious the next night ; 
but passed off without any thing very remarkable. • On the 
following night — June the first, at ten o'clock, she was aroused 
from her sleep, laboring under this strange excitement. I was 
now present. She arose from her bed, and commenced gath- 
ering her books, talking loud and angrily, as if amongst those 
with whom she was daily at school. This she soon gave up, 
and commenced singing and dancing, or rather romping, and 
jumping, with frantic and ungoverned motions. In this violent 
exercise she continued, till so exhausted that she could continue 
it no longer. Several of the near neighbors came in, one of 
whom played on an accordion, for her amusement. Nothing 
could exceed the ecstasy she evinced at the sound of the in- 
strument. Frantic with delight, she leaped and danced, but 
with little skill, till exhausted she was compelled to stop. A 
few minutes' rest, and she was again on her feet, running from 
place to place, gathering up her books, or her clothes, and hold- 
ing on to them with great tenacity, till she was too much en- 
cumbered to continue it longer. From this state, she awoke 
about two o'clock A. M., and looked wholly bewildered and 
surprised, on beholding several persons who had gathered 
around her to witness the scene. 

The next night, she ran into the same state, about the same 
hour. The notoriety of her case had attracted many persons, 
who were present and waiting. She was now more tractable, 
and the anger and violence of the previous attacks, were less 
obvious. She recognised all her acquaintances, and seemed to 
attach herself to her uncle and her aunt, and would not be 
satisfied without the presence of one or the other. Her state 
was one of great excitement. Nothing could less resemble 



SLEEP WALKING. 619 

sleep, except that her eyes were closed. ' She was as busy and 
bustling as could be conceived; running from place to place, 
down the stair case, around the house, or in any other direc- 
tion, according to the whim of the moment. She refused to be 
controlled, even by her uncle whom she would not leave, except 
for a moment at a time. But music and dancing were her 
greatest delight; and a good performer on the violin was in- 
duced to play for her. At the sound of the instrument she 
sprung on the floor and lost sight of every thing else. Her 
movements were now entirely changed ; they were in a high 
degree graceful and elegant. 

Her passion for dancing soon brought her mind to perfect 
harmony with all its common rules. On hearing the violin she 
would hasten to her room to change her clothes for her most 
elegant attire. She would return in great haste and demand a 
partner, in which she was sometimes gratified. Conscious that 
there was respectable company present, she would preserve 
the most perfect decorum, and dance with great spirit, longer 
than any one who could be induced to engage with her. The 
ease and elegance of her movements, after two or three nights 
of practice, were a matter of the more astonishment to me, 
when 1 learned that she had never seen any one dance in her 
life. In this state of excitement she would continue for five or 
six hours when she would awake, and soon afterwards fall into 
a natural sleep for the rest of the night. 

These scenes were repeated from night to night; and for 
ten or twelve days her disorder became worse. She was evi- 
dently fatigued, and many times in the day time fell asleeep, 
and in a few minutes passed into sleep walking. The regular 
returns of her paroxysms became known, and the house in 
which she resided was thronged with visitors, who came to 
witness her strange performances. At length it was apparent 
that she was rendered worse by over excitement, and she was 
refused the music which she had so much delighted in, and 
was placed as much as possible in a retired situation. By de- 
grees her paroxysms became lighter, and in about two months 
ceased altogether. She is now November 20th, 1848 — in good 
health, and seems to have grown and improved as much as any 
child of her age. Her complexion, actions and appearance, 
denote the highest and most perfect health. 

Probably no case which has been published, has afforded the 
opportunities of investigation, which have presented them- 
selves in this case of Mary Rogers. The facts which it has 
established beyond controversy are these. 



620 SLEEP WALKING. 

1. While in the state of sleep walking, her e}'es were firmly 
closed. On opening the e}-e lids with my fingers, to which she 
always consented, her eyes were found turned up toward the 
brows with a fixed and immovable force. 

2. Her knowledge of persons was the same as when she was 
awake, and she could hold conversation with them, with all 
her intelligence. She could make new acquaintances, which 
she would know again in her sleep walking state, but not 
when awake. But the acquaintances she made while awake, 
she would recognise when in her somnambulism. Her antipa- 
thies and her affections were fully preserved, and her depen- 
dence on her uncle and aunt for protection, seemed always 
present to her mind. 

3. Although her eyes were closed, and often bandaged for 
the satisfaction of visitors, she had a power of perception an- 
swering all the purposes of visiun. This power was some- 
times greater than at others, but always present. She would 
walk securely through a door, around a chair, or hat set in her 
way ; or down or up stairs, or to an} r part of town, and all this 
as safety in the darkness of night as in the day time. She 
would recognise her acquaintances at a distance, and know 
them as far as the sharpest sighted person, and this she could 
do in the night when others could not. She could discriminate 
colors as well as any one ; and w ? hat w r as more surprising, she 
cquld tell the color of any thing she touched. This was proved 
in many instances. She appeared pleased to put her hand be- 
hind her, and tell the color of any thing placed in it. A flow- 
er, or a piece of cloth, however varigated or mixed she would 
describe accurately. Gold and silver jewelry, with their va- 
rious stones or diamonds, she would describe with great ex- 
actness, never mistaking gold for silver, or missing the color of 
the stone or diamond. This she could do in the dark as well as 
in the light. In several instances she read printed characters by 
passing them through her fingers, but refused to try it after- 
wards. Being asked how she could see, she pointed to her 
eye brows, the pit of her stomach, and the balls of her thumbs, 
these said she are nrry eyes. On being requested to point out 
any person with whom she was acquainted, she would turn her 
face towards them and if they were in a crowd of persons 
point to them with her ringers. Sometimes she would seem 
uncertain of having succeeded, and go to them to feel their 
clothing and faces with her hands ; when she would decide 
with perfect confidence, and uniform success, who it was. No 



SLEEPWALKING. 62 L 

bandages over her eyes, seemed to form the least impedi- 
ment to her success. 

4. Her senses of taste, hearing, and smelling, were unim- 
paired. She appeared to enjoy the flavor of a nosegay, or the 
taste, of an apple or peach, as well as any one, and her love of 
music and conversation proved her hearing to be perfect. Her 
appetite for food was at least as good, when in this state, as at 
any other time, and she frequently ate her breakfast or supper 
while sleep walking. Of these meals she had no knowledge, 
when she would afterwards awake. 

5. No force or violence which could be safely used, would 
arouse or awake her. Tickling, pinching, smothering, or 

' throwing cold water on her, were ineffectual. She would re- 
cognise all these attempts, and appeared much amused by re- 
ceiving a hand full of cold water on her face. "Try that again," 
was her common response. Having tried many of these ex- 
periments, I at last discovered, that the passing of my hands 
along the course of the spine, with or without touching her, 
produced a powerful effect. At the first trial she sprang for- 
ward and aw r oke in a moment. But it was near the time at 
which she was expected to awake. The next trial was made 
in the midst of the paroxysm. Expecting some resistance I 
had her held; but although I did not touch her, she screamed 
aloud, broke loose, and fled under a table in the greatest con- 
sternation. She was by this time awake, demanding to know- 
how she was thrust under the table and by whom. The fear 
which this experiment produced was so alarming that it was 
never repeated. 

6. For a few days of the time at which the paroxysms of 
somnambulism were strongest and most frequent, she appeared 
fatigued and dejected ; but even this soon passed off, and, 
there remained not the slightest appearance of ill health or in- 
convenience of any kind. At the close of her disorder, Mary 
Rogers was in as perfect health as could be desired. 

7. The sensibility which was aroused by passing the hands 
along the spine, continued during her waking hours. She could 
feel the approach of my hands at the distance of two or three 
feet, and whether aleep or awake never failed to recoil from 
them with great alarm. The same sensation was produced by 
standing before her and directing my fingers towards the pit of 
her stomach. At the same time, she w 7 ould with great pleas- 
ure, take hold of my hands, lean on me, or allow me to take her 
up in my arms, provided I avoided bringing my hands in contact 
with the spine or epigastrium. This sensibility to the passing 



622 MESMERISM. 

of the hands along the spine, or approaching the epigastrium 
with the ringers has entirely passed off! On repeating the ex- 
periments a few days ago, they produced no effect whatever. 

8. I was induced to try whether she was not a proper sub- 
ject for the operation of animal magnetism. She gave her con- 
sent when awake, and I found that in -four or five minutes, she 
was in a sound magnetic sleep. I made no attempt at experi- 
ments with her while in this state, and after about ten minutes 
removed the impression so that she awoke. She never again 
gave her consent to be placed in this state, and it has not been 
attempted. 

I have dwelt long enough on this remarkable case of somnam- 
bulism. But itis due to the reader that I should state the particu- 
lars in which it differs from, or agrees, with other cases which 
have been reported. There is nothing new in sleep walking — 
cases of it have been recorded, more than two thousand years 
ago. And there is probably nothing new in any respect, in the 
case of Mary Rogers. But I know t of no case, the most un- 
accountable traits of which have been so fully developed and 
undeniably attested ; and some of the facts have at least re- 
mained unnoticed. Other somnambulists have performed in 
the dark all which they could have done in the light ; oth- 
ers have performed works in painting, and composition, which 
they were unable to do in their waking hours ; and others have 
heard sounds, taken food and sought in solitude their enjoy- 
ments ; but it was reserved for Mary Rogers to play her part 
as a social being, enjoying in this state, the society of others, 
extending her acquaintance, choosing her pleasures, improving 
her manners and acquiring new accomplishments. Our he- 
roine alone, has with bandaged eyes, by day or night, perceiv- 
ed and known her acquaintances, at the distance of sixty or 
seventy yards : she alone has discriminated colors as readily 
by the touch as others by sight ; and it is she only, of all the 
sleep walkers, who has demonstrated the perception of the 
hands of another when approaching, within two or three feet of 
her spine or epigastrium. These facts are new ! Who can 
say they are unimportant ? 

MESMERISM ANIMAL MAGNETISM. 

It shall be my endeavor to treat of this subject, without giv- 
ing any opinions of my own. It may not be amiss, however, 
to state, that I am no believer in the existence of a magnetic 
fluid in the human body. The phenomena produced by the 



MESMERISM. 623 

efforts of the mesmeriser, seem to me, to have no relation 
whatever with the common properties of matter. If there be 
in realit}', a difference between the operations of the mind, 
and the common properties of matter, it is in these experi- 
ments that we are to expect it to be made manifest. That 
there is in truth such a difference, I have no doubt. Nor is it 
evident to me, that these phenomena are the same with those 
of which we have spoken in the articles on somnambulism, 
and excessive sensibility. The resemblance between mesme- 
rism and these diseases, when closely investigated, will ap- 
pear extremely remote. But I have said I would not dwell 
on the particular views I have of this subject, but present the 
facts I have seen. 

Mesmeric sleep is brought on by the operation of one mind 
upon another. I believe that in the first instance, the person 
to be mesmerised, must consent to be placed in that condition. 
When this consent is yielded, the mesmeriser, by fixing his at- 
tention on the business in hand, and willing powerfully that his 
subject shall pass into this - state ot mesmeric sleep, accom- 
plishes his object by powers of which he is himself uncon- 
scious. The position which he should occupy to the person 
over whom he is to exert this influence, seems to be a matter of 
no great moment. The attention of the person to be mesme- 
rised, must be brought to the subject ; and this is accomplish- 
ed in various ways. Some take hold of the hands, and by 
gently touching with very light friction on the thumbs, secure 
the attention of the person to be operated on. Others place 
in their hands pieces of money on which they desire them to 
look steadfastly. A few minutes is commonly a sufficient time 
to prove whether the mesmeriser is capable of inducing this ex- 
traordinary state. If the subject passes into the state desired, 
he will appear as if in a profound sleep. 

In this state of mesmeric sleep the subject of the operation 
loses all sensibility to external objects, except such as are de- 
rived through the mesmeriser. Through his senses the person 
mesmerised, sees, hears, and feels. Through his own senses, 
he neither sees, hears, nor feels. There is no doubt of the 
fact, that the most awful surgical operations have been per- 
formed on persons in this situation, without their being con- 
scious of it. I have seen many minor experiments made to 
test this question. I have seen a large pin thrust through the 
ear, and other injuries equally painful endured, without the 
slightest appearance of pain or any sensation whatever. At 
the same time, pluck from the head of the mesmeriser a single 



624 MESMERISM. 

hair, and the mesmerised would complain. Give him any 
thing to taste, and the mesmerised would taste : give him 
food, the mesmerised would appear to enjoy it fully as much 
as he did. Apply to his nostrils any thing odorous, and the 
flavor would be enjoyed ; give him snuff, and the mesmerised 
would be the first to sneeze. These facts I state from my own 
experience, having, in various instances, succeeded, by my 
own will, in placing persons in this situation, and having made 
all these experiments myself. 

But the dominion of the will of the mesmeriser over the mes- 
merised, is perhaps the most astonishing of these develop- 
ments. To his voice the mesmerised yields implicit obedi- 
ence, and to his desires, though not expressed by voice or 
sound, or movement of any kind, he is equally obedient. If 
the mesmeriser, looking on the subject of his experiments, shall 
desire him to rise from his seat, he does so ; if to kneel and 
pray, or to do any thing the reverse of this, it will be instantly 
accomplished. And all this is done in a way wholly incom- 
prehensible to the mesmeriser, and by an effort of his will, no 
greater than that which would have enabled him to accomplish 
the same thing himself. All these things I have tested in ex- 
periments that I have made myself. They are known to me 
by a testimony as high and convincing as the knowledge of my 
own existence. No one can in his own person, perform these 
experiments without knowing that they are true. The truth, 
then, of these strange facts, needs no broader or firmer foun- 
dation. He who reasons as if they were not true, will al- 
ways be in the wrong. 

This is a very small portion of the facts which I have seen 
shown by persons in the mesmeric sleep. I have arrayed 
them together as being the most convincing of the great fact of 
mesmerism. It may not be amiss, however, to mention some 
of the additional facts of which I am as well convinced, as of 
those I have already stated. This state of mesmeric sleep is 
capable of a great variety of operations. It can be rendered 
by the will of the mesmeriser, partial. He can take off from 
the eyes the appearance of sleep, and give to his subject the 
capacity of seeing, hearing, and feeling ; and yet all that he 
sees, and all that he hears, shall have to him the appearance, 
that the mesmeriser chooses that it shall have. He will, for in- 
stance, cause him to see objects which are not present. He 
will hold to him a hat, and tell him it is a basket of fish — de- 
siring him to take hold of it ; and then- tell him it is a basket of 
serpents — all of which the mesmerised will fully believe ; and 



' MESMERISM. C25 

his actions will so correspond with this belief, that it will be im- 
possible to doubt his conviction. Equally strange are the phre- 
nological developments which are made in this state. Of 
these experiments, T have seen a great many. Bring the fin- 
gers of the mesmeriser in contact with those parts of the head 
which contain the organs of the brain pertaining to certain ac- 
tions, and the mesmerised is instantly thrown into a great ex- 
citement in reference to that particular function of the brain. 
The variety, interest, and beauty of these experiments, can 
hardly be conceived. 

The influence which is exerted over these persons, by the 
passing of the hands of the mesmeriser along their bodies, bears 
perhaps the nearest resemblance to a magnetic influence. By 
placing the hands on the head of the mesmerised, and passing 
them downwards towards the feet, over the muscles, a pow- 
erful contraction takes place, which, when carried over the 
breast and down the body, sometimes almost impedes breath- 
ing, producing the appearance of the greatest distress. The 
limbs, at the same time, become so contracted, that the sub- 
ject is incapable of moving them ; and in this state, the mes- 
meriser has it in his power to awake them, leaving them whol- 
ly incapable of moving. Yet from this state, the subject is re- 
leased in a moment by a reversed motion of the hands, passing 
from the feet upwards above the head, as if it were to throw 
off" from him a tangible fluid. This mode of releasing persons 
from a mesmeric sleep seems to be independent of the will of 
the mesmeriser. At least, 1 have found persons thus circum- 
stanced to awake, from motions of this description, without 
any desire on my part that they should do so. 

These phenomena differ very widely in different cases. 
Some subjects, when thrown into a state of mesmeric sleep, 
are scarcely capable of responding to any of the experiments 
which have been mentioned. All, however, seem to be ca- 
pable of improvement, and when mesmerised from time to 
time, are constantly gaining in the power of exhibiting all the 
the experiments, which are commonly practised in such cases. 

If I am asked for what purpose is all this matter brought 
forth, I shall not find it easy to give a satisfactory answer. 
That facts so strange ought to be investigated, and if there is 
in them, any thing of good or ill, it ought to be made known to 
the world, appears to me to be self-evident. That this power, 
if it could be made more manageable, might be made an ex- 
ceedingly valuable addition to our means of averting pain in 
surgical operations, there can be no doubt. That it is equally 
40 



626 MESMERISM. 

capable of being used for averting pain from other causes, I 
am equally confident. To what other purposes of good it is 
capable of being applied, I know not. As a development of 
the power and attributes of the mind, there can be no doubt 
that this is by far the most interesting field which philosophy 
has in its custody. That it has developed the power of one 
mind to act on another, under circumstances, and to an extent 
wholly unexpected, no one can doubt. That some of the facts 
it presents, signify an operation of the mind wholly distinct 
from the ordinary operations of matter, seems to me perfectly 
clear. That the voluntary power of the mind, passes from 
the body of the mesmeriser, to perform, at a distance, its office, 
in that of the mesmerised, can hardly be questioned. I have 
sat in my place, at a distance of perhaps thirty or forty feet ; 
looking at one who had been placed by my efforts in this 
condition. By my will she has risen ; by my will she has 
kneeled ; by my will she has prayed. What influence has 
passed from me which should induce these actions ? Is it not 
a separate movement of the mind, passing from one body, 
through space, to another ? And does not this go farther to 
prove a separate existence of the mind, than any other fact 
which has yet been elicited by philosophy ? But the particu- 
lar views I may have of this matter, are of little consequence. 
Mesmerism cannot be excluded from the healing art. Its ex- 
istence and wonderful influence are not disputed. The most 
powerful intellect ought to be brought to its investigation. It 
is our duty to understnad it. 

"While reading the proof of this article, I am presented with 
an essay in the Philadelphia North American, giving some ac- 
count of the experiments of Baron Reichenback, of Vienna, 
" On magnetism and certain allied subjects." I had seen that 
the Baron had taken a place amongst the believers of the 
strange doctrines dimly shadowed by Mesmer and others. 
But Cuvier had long ago done the same thing ; and even his 
great name had weighed nothing on this side of the British 
Channel. I was still left to fear, that the place I have ven- 
tured to assume, would be regarded as that which should be 
assigned to low credulity and ignorance. I am pleased that 
one of the lords of the newspaper press, has lowered the nos- 
tril of the sneerer, and consented to give to animal magnetism 
or mesmerism, a fair showing before his readers. This act of 
a popular editor proves a great deal to my mind. It satisfies 
me, that the enlightened citizens of Philadelphia, will no lon- 
ger tolerate the attempts to put down facts known to every bo- 



DISEASES OF FEMALES. 62? 

dy. No man who is ignorant of the great truths which prove 
the existence of the animal magnetism, need remain so a single 
day in Philadelphia. I think a new era has arisen. We shall 
soon see the great followers of public opinion on the right side 
on this question. I regret that it has not been in my power to 
inform myself better of the present state of this new science on 
the continent of Europe. 



DISEASES OF FEMALES. 

Some of my readers will look with interest for my essay on 
the diseases of females ; they will find it short, but I trust suf- 
ficient to supply the necessities of such as may not have it in 
their power to consult a physician. 

Female diseases may be said to have no existence before 
the age of puberty. At this age the flow of the menses takes 
place; and, except during pregnancy., should return every lu- 
nar month, till the woman is past the age of childbearing. The 
period at which this discharge should appear, differs considera- 
bly in different latitudes. Between the tropics, it is expected 
at twelve years or sooner ; and in high latitudes it does not ap- 
pear till the twentieth year, or even later. In the latitude of 
my observations, about thirty-three degrees North, it appears 
from the thirteenth to the sixteenth years ; and I have seen it a 
year or two sooner or later, without any appearance of ill 
health. The time at which the discharge should disappear, is 
from the forty-eighth to the fifty-fourth year, and there are 
some exceptions also to these periods of time. 

The approach of puberty, is a period of anxious solici- 
tude to mothers, who look on the uncertainty of its perfect es- 
tablishment, with a dread which is little felt by the child, 
which is now to ripen into the functions, and bear the respon- 
sibilities, and it may be, the pain and sufferings of a woman. 
It is hardly necessary to solicit the watchful guardianship and 
care of mothers, to these tender and interesting objects. It 
may not be amiss, however, to say, that they should by no 
means allow the period of the flow of the menses to arrive 
without apprising the child of the change which she is to ex- 
pect. I have known instances in which children thus arriving 
at maturity, have ignorantly sought in solitude the removal of 
the stains they saw, by plunging into cold water. The ill ef- 
fects which have often followed such acts, ought to be known 
to every woman. Far from tolerating neglect at such a peri- 



628 SUPPRESSION OF THE MENSES. 

od, I have only to remark, that children at this age should be 
with their mothers or others who would take special charge of 
them. They should by no means be exposed to cold without 
sufficient clothing ; and the excitement of social intercourse 
should be very much restricted. 

The decline of the menses finds the woman with as much 
prudence and knowledge, as she is likely to acquire. She 
may not, however, be apprised that no medicine is required to 
be taken at such a time. She should avoid unnecessary fa- 
tigue, and allow to nature time for the cessation of a discharge, 
which has been so long established. If her health gives way, 
and especially if any disorder of the womb makes its appear- 
ance, she ought without delay to consult an experienced phy- 
sician. 



SUPPRESSION OF THE MENSES— AMENORRHEA. 

Independent of the necessity of the menstrual flux, in the 
purposes of propagation, it seems impossible for the female to 
enjoy health, should it fail to appear at the time indicated by 
nature. When this time has elapsed without the appearance 
of this discharge, it has been termed a retention or obstruction 
of the menses ; when after the discharge has been established, 
showing that it is the effect of disorder, it has been termed sup- 
pression of the menses. The remedies applicable to these ca- 
ses, are the same, except in a few cases arising from imperfect 
development or defective anatomical structure. 

The suppression of the menses, when affecting } T oung fe- 
males, produces that peculiar disease, which has been known 
by the term green sickness. The patient becomes exceeding- 
ly pale, with great languor, listlessness, depraved appetite, in- 
digestion, and palpitation of the heart ; a low degree of fever 
experienced for many hours of the day with pains in the limbs, 
and sometimes head-ache attends it. These symptoms con- 
tinue for an indefinite time, sometimes for several years, in 
which case the health usually becomes worse and worse, to an 
alarming degree. When the disease has continued for some 
length of time, the tongue becomes foul, the breath exceeding- 
ly offensive, bowels costive, with very defective appetite, and 
great despondency in the mind. Hysterical symptoms com- 
monly, of a mild character present themselves. They are 
manifested by sudden attacks of palpitation of the heart, with 
the characteristic smothering or choking, as if a ball had arisen 



SUPPRESSION OF THE MENSES. 629 

from the stomach, and become fixed and immovable in the 
throat. As the disease progresses, the circulation becomes 
affected, the pulse which had been quick at first and without 
much extra force, becomes full and bounding, and the arteries 
are seen- beating with great violence at the sides of the neck. 
These symptoms may occur in children too young to experi- 
ence the menstrual flux. If in this climate, they occur to girls 
under fifteen years of age, they are to be treated without any 
reference to the function of menstruation. 

causes. 

It will be in vain to dispute with women the destructive 
power oi' suppressed menses, and equally hard to make them 
conscious of the common fact, that the suppression is the mere 
consequence of ill health. The moment the menses fail to ap- 
pear at their regular time, that fact is considered accountable 
ibr every other ill which attends it. This may be true in a 
few instances; the menses is sometimes suddenly arrested by 
exposure to wet and cold, during its flow. Sudden emotions 
of the mind have produced the same effect, and many other 
causes have probably led to the same result. Great derange- 
ment of the health, and sometimes painful aberration of the 
mind follow, and are kept up till nature is re-established in 
her regular periods, and then every s\ 7 mptom of the disease 
disappears ; but these cases are rare in comparison with the 
great number of those who become first diseased, and have in 
its course, a suppression or retention of the menses. It may 
be added, that in a vast majority of cases, a retention of the 
menses is only an evidence, that the health of the woman is of 
a grade too low to admit of the propagation of her species. For 
the flow of a healthy menstrual flux, is according to the estab- 
lished law of nature an evidence, that the individual is in a 
state of capability for the propagation of the species. This it 
is evident, ought not to be the case when the body is too much 
diseased, and nature has accordingly provided for a suppres- 
sion of the discharge under such circumstances. This view 
of the subject, should warn us against the interminable use of 
such remedies as are thought to force the menstrual discharge. 
They are at best, of but doubtful efficacy, and were they a 
thousand times more efficient than they are, and could they put 
it into our power to command at pleasure the appearance of 
the menses, we should be as far from having relieved many of 
these cases, as we should without it. 



630 SUPPRESSION OF THE MENSES. 

TREATMENT. 

It is obvious that we have not got merely the name of a dis- 
ease to prescribe for, when the menses is retained or suppres- 
sed. When the disease has arisen from any sudden cause, 
and the patient has been previously in the enjoyment of good 
health ; and when from the circumstances of the case, there is 
no probability that an incipient pregnancy may have arrested 
the discharge, an active course of treatment for the renewal of 
the discharge is proper. The remedies should conform to the 
symptoms. If there is nervous excitement, it should be quie- 
ted by anodynes, thirty or forty drops of laudanum maybe ta- 
ken once or twice in twenty-four hours. If there is much pain 
in the loins with coldness of the extremities, the feet may be 
bathed in warm water at the time, and warm fomentations used 
over the region of the pelvis. If there is much pain in the 
head, bloodletting will be proper, and a cathartic administered, 
composed often grains of calomel, and ten grains of aloes, made 
into pills. Should the disease continue with more or less ir- 
ritation, at the termination of a month, emmenagogues should 
be used ; sixty drops of the tincture of black hellebore, should 
be given in the course of the day for three days in succession. 
Fills composed of aloes alone, about four grains in each pill 
may be taken at the same time evening and morning. Ergot of 
rye has of late, been much used in these cases, ten grains of 
powdered ergot ma} 7 be given three or four times a day. But 
all these remedies should be suspended if they are not success- 
ful in two or three days, for there can be no greater mistake 
than the protracted use of these forcing remedies, when the 
general health of the patient is in a state forbidding the men- 
strual flux. 

Chronic cases of suppressed menstruation are to be treated 
with strict reference to the general health of the patient. The 
use of a forcing emmenagogue without a proper course of pre- 
vious treatment, would be almost certain to fail of success, and 
should it bring on the discharge, the health of the patient will 
be quite as likely to be injured as benefitted by it. The symp- 
toms of this disease indicating the greatest debility, and pover- 
ty of the blood in red particles, has pointed to the use of iron 
as the great remedy. This article has maintained its reputa- 
tion in these disorders, and the confidence of medical men has 
been rather increased than lessened by the labors of chemists 
who have of late investigated the subject. Where there is 
great paleness of the face with debility, iron is the first Feme- 



EXCESSIVE FLOW OF THE MENSES. 631 

dy ; the precipitated or red carbonate is one of the best prepa- 
rations of this remedy ; but the brown carbonate which dif- 
fers somewhat in its composition, but has been much longer in 
use, is. probably as good a remedy. Ten grains of either of 
these articles may be given at a dose two or three times a day. 
It may be made into pills in combination with while ginger or 
other agreeable spices. In either of these forms, the remedy 
may be continued for a considerable length of time. Where 
the bowels are torpid, they may be acted on by aloetic pills 
given from time to time as the case may require. Where there 
is good reason for believing that the liver does not perform its 
function well, calomel or blue pill may be administered. 
Four grains of blue pill may be taken in a pill at night for six 
or seven nights in succession, but must then be suspended 
where it is thought advisable to avoid a salivation. 

The prostration of strength, paleness and bloated counte- 
nance do not always signify the absence of inflammation. On 
the contrary, even where patients are very low, if there is con- 
siderable pain in the head, with burning feet at night and great 
restlessness ; remedies of a more active kind, are to be admin- 
istered. Blood should be drawn from the arm in small quan- 
tities at intervals not very distant ; eight ounces of blood may 
be taken in this way twice a week, and a brisk cathartic of 
calomel and jalap may be given at the same time. These 
remedies may be repeated according to circumstances, and it 
requires great judgment to know when the}' should be sus- 
pended, and the tonic plan above recommended, adopted. 
No certain rule can be given for this ; but close observation and 
diligent attention, to the beneficial effect of the remedies used, 
must direct us in their continuance. In many instances, it is 
best to persist in the use of the depleting and cooling treatment, 
with a very low regimen, till all symptoms of fever have dis- 
appeared ; and then to rely on a gradual increase of nutri- 
tious food with moderate exercise without any stimulating or 
tonic remedy whatever. 



EXCESSIVE FLOW OF THE MENSES— MENOR- 
RHAGIA. 

Every woman is conscious that she can not have health with- 
out a regular discharge of the menses; but what the anuunt 
of this discharge shall be, to enable the individual to continue 



632 EXCESSIVE FLOW OF THE MENSES. 

in health, is very uncertain. In some persons, the flow con- 
tinues for six or eight days, involving a discharge of several 
pounds in the time, without appearing in the least to interrupt 
the regular, healthy functions. In others, the discharge will be 
limited to a day or two ; and in its amount not extend to the 
tenth part of what I have mentioned, and yet the individual 
preserve uninterrupted health. It miy be considered as a gen- 
eral rule, that those in whom the discharge continues from two 
to four days, enjoy the best health. It may be observed, that 
those in whom the menstrual discharge is considerable, are gen- 
erally very delicate, and commonly lean : those in whom it is 
less, are apt to put on more flesh, and to wear the appearance 
of higher health, but to this rule there are exceptions. 

When the discharge of the menses from its excess, or Ions; 
continuance, produces manifest debility and disorder, it be- 
comes a disease worth}' of attention. When the excess is very- 
great, the disorder becomes more alarming ; and, in many in- 
stances, seems to lay the foundation of fatal disorders. The 
time of life at which this disorder may happen, is uncertain. 
I have seen it occur to young.girls on their first menstruation. 
More commonly, however, it happens to married women, who, 
from some cause, fail to become impregnated. The point at 
which it shall be considered a disease requiring medical treat- 
ment, is uncertain. Where it is not very excessive, I should 
rather advise patience and the forbearance of the use of reme- 
dies. When it is fairly entitled to be considered a disease, the 
following considerations are to be had in view in its treat- 
ment. 

A good deal has been said in reference to the character of the 
discharge ; and the question has been, " was it an excessive 
discharge of the menses, or a mere discharge of blood ;" This 
question is not always easily answered; but it is not ver} 7 im- 
portant, for the remedies applicable to the one case, and the 
other, are very much the same. In almost every instance the 
disorder will make its attack at the regular period of menstrua- 
tion, and the continuance of the flow will be longer, than the 
period which would be proper, to the individual. The quan- 
tity discharged in a given time, is sometimes so great, as to pro- 
duce the most alarming symptoms. As the disease progresses, 
the term during which the flow continues is lengthened, so that 
in bad cases, there, sometimes, is scarcely any interval be- 
tween the cessation of one course, and the bern'miin^ of an- 
other ; but in all cases, about the time at which the menses 
should flow, the discharge will be very much increased, and if 



EXCESSIVE FLOW OF THE MENSES. 633 

there is any clanger from the mere excess of the discharge, it 
will then be manifest. 

REMEDIES. 

The remedies which are proper to suppress the discharge, 
are to be first considered, and the most important of these is 
absolute rest in a horizontal position. The instant it is decided 
that it is an attack of serious disease, the person affected should 
retire and remain in bed. Should the discharge continue un- 
abated for an hour or two, cold applications should be made in 
the form of wet towels, laid across the lower part of the abdo- 
men, and near the organs of generation. If the pulse is high, 
and the face flushed, blood should be drawn from the arm. If 
the flushing still continues, and this is no uncommon case, a dose 
of tartar emetic may be given. After this, if there continues 
any necessity for it, antimonial mixture may be given in broken 
doses, so as to keep up a degree of nausea which may be con- 
veniently borne. Few cases resist these means more than a 
day or two; but there are instances in which the hemorrhage 
is of the most obstinate and dangerous kind. In such instan- 
ces, a physician should be called, and a tampoon introduced, 
so as to resist the discharge of blood in every possible way. 
After the discharge has continued a day or two, and the time 
arrived at which in a healthy state it would have come to a 
termination, it may be proper, in case of necessity, to exhibit 
astringents internally. The acetate of lead, may be given, in 
doses of three or four grains, once in eight hours. Laudanum 
may be added, if there is much pain, or if the debility which 
has been brought on is in any degree alarming. The ergot of 
rye "has been administered with some success, in these cases. 
Ten grains of this article in powder may be given in syrup, 
two or three times a day. By these remedies, used with judg- 
ment and perseverance, almost every case of menorrhagia will 
be brought to a close in a few days ; but the disease may be 
expected to return at the next period of regular menstrua- 
tion. 

In the interval of the discharge, the treatment of these cases 
is a matter of more uncertainly. A prudent use of tonic medi- 
cines and other restorative means, is so reasonable, that we al- 
most involuntarily have recourse to them ; but the patient will 
often be found too feverish and excitable to bear the use of such 
remedies. Very commonly the pulse is full, and the least stimu- 
lant will produce an excitement, with giddiness, and some de- 
gree of fever, which will forbid the exhibition of such a remedy. 



G34 PREGNANCY AND ITS DISEASES. 

It will then be proper to commence with tonics of the mildest 
stimulating influence. The vegetable bitters deserve the fi rst 
place in this respect, and, although there may be a thousand 
plants which yield the bitter principle, and are tonics in their 
effects, I think there is but little gained in substituting any thing 
for the gentian, which I have so often mentioned as the very 
best of this class. The extract of gentian made into pills with 
ginger, or powdered cinnamon, may be given in these cases. 
Three or four of these pills, of the common size, may be given 
in the course of the day ; at the same time, a diet reasonably 
generous, and exercise in the open air, will be beneficial ; but 
the exercise is not to be pressed beyond the perfect ability of 
the patient to sustain it. Where the case does not appear to 
bear the stimulating treatment well, and the patient is affected 
with more or less fever, throbbing pulse, white tongue, head- 
ache, giddiness, and symptoms of that description, the use of 
the hip bath is entitled to high commendation. This bath is 
taken by sitting in water in a shallow tub, in a convenient posi- 
tion; every one must contrive this for herself ; but it should be 
practised for an hour at a time, and repeated according to cir- 
cumstances. In these cases it has the best effect in lessening 
the irritation, nervous excitement, and inflammatory symptoms 
we have mentioned.* Where these inflammatory symptoms can 
be reduced to a point which admits of the use of stronger and 
more reliable tonics, composed of preparations of iron, they 
should be used in a decided way. They should be commenc- 
ed with, as soon after the flow of the menses has stopped, as 
possible, and used for one or two weeks, and then discontinued 
till after the next period. Ten grains of carbonate of iron, 
given in syrup three times a day, is perhaps the best prepara- 
tion of this remedy. The same quantity made up into pills 
with a portion of white ginger, or powdered cinnamon, may be 
taken at the same time. Other preparations of iron may be 
substituted*; but I do not know any particular reason for pre- 
ferring one of them over another. 



PREGNANCY AND ITS DISEASES. 

Doctor Rush insisted on it, that pregnancy was but a nine 
month's disease. Other authors have not agreed to consider 
it in this light ; but all agree that it is productive of many in- 
conveniences, ills, and disorders. The symptoms which pre- 



PREGNANCY AND ITS DISEASES. 635 

sent themselves in the course of gestation are striking. We 
may mention nausea, vomiting, ptyalism, dyspepsia, anorexia, 
constipation, colic, diarrhoea, dysentery, tenesmus, hemor- 
rhoids, oedema, and varicose veins. To this list may be ad- 
ded, affections of the mind, which vary in different cases. It 
will not be expected that each of these inconveniences will be 
entitled to more than a passing notice. The nausea and vomi- 
ting which are usually the first signs of impregnation, common- 
ly disappear after the third month is completed. They are, 
however, exceedingly disagreeable, and sometimes continue 
with great obstinacy almost during the whole course of preg- 
nancy. These symptoms are frequently attended with ano- 
rexia, or a loathing of some articles of food, which are for a 
time, held in the greatest aversion. This loathing of food is a 
peculiar symptom, and sometimes seems of itself to aggravate 
the vomiting and sickness at the stomach. It seems to exist 
in many instances, when the presence of food in the stomach 
is every way desirable. Very often, an effort made to take 
food, in spite of a loathing appetite is found to be extremely 
beneficial — the taking of a small portion of food removing the 
nausea and loathing at the same time. It is not often that 
remedies appear to affect a great deal in removing nausea. 
Emetics have been recommended ; if they are taken, they 
ought to be of the mildest kind. Twenty grains of ipecac for 
instance, in a table spoonful of water. Seidlitz powders taken 
in an effervescing state, have, in some instances, seemed to 
afford relief; but the conclusion of the third month of preg- 
nancy, commonly brings a relief that no remedy can equal. 
The constipation of the bowels, and colic, very often seem to 
go together. They are by no means unfrequently present, 
and the fits of colic that sometimes occur, are seldom violent 
or dangerous. Constipation is to be hindered or removed by 
every means in our power. If a lower diet does not accom- 
plish this, medicines should be used from time to time. Cal- 
cined magnesia, with or without rhubarb, is perhaps the best 
article, which can be su 2: jested for the relief of this state of 
the bowels. If it proves offensive to the taste, there is no ob- 
jection to the occasional use of a Seidlitz powder, or any other 
equally mild cathartic medicine. The heating and drastic ca- 
thartics which form the basis of almost every cathartic pill in 
use, are particularly improper for pregnant women ; causing 
as they do, a great deal of heat in the lower bowels, tending 
to produce several inconveniences to which these persons are 
particularly subject. The piles or hemorrhoidal affections, 



636 PREGNANCY AND ITS DISEASES. 

which occur to pregnant women, are to be regarded as a tem- 
porary disease ; for they generally disappear soon after the 
birth of the child. The cedematous or dropsical swellings of 
the legs, and the varicose veins, which are frequently found to 
be very troublesome, are to be viewed in the same light. They 
are temporary affections, and will disappear in due time. In 
some cases, however, these swellings of the veins and limbs 
become an inconvenience so serious, that medicines for the re- 
moval of the water thus collected, become absolutely neces- 
sary. A brisk cathartic is, many times, a proper remedy in 
these cases. Cream of tartar and jalap, given in broken doses, 
so that its action may be restricted to proper bounds, is per- 
haps the best. If the pulse is high, bloodletting is a remedy of 
more value for these particular symptoms, than any other. The 
acidity of the stomach, which is, with many, a constant incon- 
venience during the whole period of pregnancy, may be re- 
moved by the use of absorbent medicines, such as prepared 
chalk, carbonate of magnesia, and others. The carbonate of 
soda and of potash, are remedies for this affection, and may 
be used from time to time. An itching and burning pain 
about the organs of generation, is a common symptom. For 
this, a solution of a drachm of sugar of lead and an equal 
quantity of white vitriol may be made in a quart of water, 
and the parts bathed with it, two or three times a day. 
The food which should be taken by persons in this state, 
is a matter of due consideration. It ought to be light and 
easy of digestion ; but, in many instances, I might say 
in most instances, the appetite of persons in this situation 
is untractable. They have their preferences, and it is not 
easy, for them to take articles for which they have not a 
particular relish ; nor has it been found as unsafe as might 
have been expected to gratify them, more or less, in the 
bent of their inclinations in this respect. Still it is very im- 
portant, that they should be kept within limits suited to the 
strength and digestive power of the stomach. Many, I have 
no doubt, destroy themselves by persisting in the use of im- 
proper food in too great quantity. It may not be amiss to add, 
that if persons during pregnancy, are attacked with any dis- 
ease, an intermittent or remittent fever, a pleurisy, or any 
other general disorder, they should use the remedies which 
are proper for these diseases, with not much regard for the 
fact, that they are in a state of pregnancy. In fact, as a gene- 
ral rule, it becomes important to use remedies still more ac- 



CHILD-BED FEVER. 



03' 



live and decided, than would be proper to the same person' un- 
der other circumstances. 

I have thus in a single paragraph mentioned the most im- 
portant disorders of pregnancy, and their remedies. It is too 
brief to be satisfactory, but I have not room to enlarge on the 
subject. I will close by remarking, that many females who 
have reached an advanced age, find the burthen of pregnancy 
almost too much to be borne. Such persons should make no 
violent resistance to their disorders. They require rest, pa- 
tience, and time. If their digestive power is bad, they should 
conform to its weakness, by a rigid forbearance. If supper or 
breakfast disagrees with them, they must forbear the indul- 
gence of eating, till they have found by experience, what they 
can safely take. If rich food proves oppressive, try the poor- 
est, even vegetables or ripe fruit of any kind. 



CHILD-BED FEVER. 

This disease is a violent fever, brought on by inflammation 
of the womb, and its appendages. It is, in many instances, 
exceedingly dangerous, producing death in a few davs. No 
disease to which the lying-in woman is subject is so much 
dreaded as this. It has, in many instances, appeared to be 
epidemic, attacking, about the same time, many women who 
happened to be in this condition. In lying-in hospitals, it has 
sometimes appeared with a violence scarcely equalled else- 
where. The importance of the subject has caused a corres- 
ponding degree of attention to be given to its study, and in- 
vestigation. Many post mortem examinations have been 
made of those who have perished by it; and it has been found 
that almost every one of the abdominal viscera, were more or 
less affected. The womb and its appendages, as well as its 
veins, have many times presented the evidences of the highest 
degree of inflammation, and sometimes suppuration and gan- 
grene. 

The attack of this disease is first noticed by the appearance 
of a chill, which is soon followed by violent pain and fever. 
The pain is sometimes seated in the region of the womb, but 
more frequently, as far as I have observed, in one side of the 
lower part of the abdomen, near the groin. Very soon violent 
pain and great tenderness spread to all parts of the abdomen. 
Commonly, a sudden swelling or enlargement takes place, and 



63S CHILD-BED FEVER. 

violent pain is produced by pressure on any part of the ab- 
domen. The pulse becomes exceedingly rapid, and after a 
few hours is sometimes very much reduced in its force. The 
patient, in the mean time, is entirely prostrated, and scarcely 
able to move in her bed. The expression of countenance is ex- 
ceedingly dejected, and full of distress. Her breathing, in the 
mean time, becomes oppressed, and delirium is a frequent 
symptom. If these symptoms go on without any means being 
used to arrest them, a fatal termination is veiy much to be ap- 
prehended in four or rive days. It is not every case, however, 
that runs on with this rapidity, or commences with this degree 
of violence. I have seen many instances, in which a fever, 
with pain in the regions I have described, and all the symp- 
toms I have mentioned, was present, and still the case was not 
a veiy formidable disease. I have seen such cases get well 
under the most feeble and inefficient treatment. But this dis- 
ease is always entitled to be considered a very serious afflic- 
tion, and no time should be lost in administering the proper 
remedies. 

TREATMENT. 

The great prostration and rapid pulse which attend these 
cases, were, for a length of time, considered by physicians, as 
evidence of a disease of the highest typhoid grade. Such pa- 
tients were therefore treated with the strongest stimulant and 
tonic medicines which could be procured. About the time I 
commenced the practice of medicine, great confidence was 
reposed in the use of spirits of turpentine in large doses. 1 
soon had an opportunity of seeing their effects, and sad was 
the result. It was not long, however, before a better view of 
this disease was taken, and remedies of an opposite character 
were brought into use. The first of these remedies is blood- 
letting, which, from the inflammatory character of the disease, 
is plainly indicated. The only difficulty in coming to the con- 
clusion of this absolute necessity, is the weakness and rapidi- 
ty of the pulse. Blood, however, should be drawn freely on 
the first day, if possible. So high is the confidence now repos- 
ed in this remedy, that almost all others are entirely thrown 
aside. Physicians think it only necessary to bleed, and if the 
patient is not relieved, to bleed again. In my own practice, 
I am not so thorough a bleeder. If I am called in due time, 
which is far from being always the case, I bleed with suffi- 
cient freedom ; but a single bleeding is commonly all that I 
find necessary. I do not rely on this remedy to the exclusion 



CHILD-BED FEVER. 639 

of others; I may say, that I do not rely on it as a principal 
remedy. The remedy in which 1 have most confidence, is 
calomel and gambonge. Take of calomel, thirty grains, gam- 
bouge in powder, eight grains — to be mixed together, and made 
into eighi pills. Of these pills, give two every two hours until 
an active cathartic effect is brought on. As soon as this reme- 
dy operates as a cathartic, the patient will feel the great re- 
lief which has been afforded, and probably the symptoms from 
that moment give way. I am not sure, that 1 have met the 
disease in the formidable type in which others have seen it, 
but I am perfectly sure, that the remedies I offer, are almost 
absolutely certain to afford entire relief when administered in 
time. I seldom resort to the lancet, but rely on the powerful 
cathartic I have mentioned. If after the operation of this reme- . 
dy, the patient is still in pain, give a dose of laudanum, or of 
morphine. Offer nothing more during that day. She will 
probably obtain perfect ease and rest for many hours. Should: 
the pain return the next day, or at any succeeding time, repeat 
the dose exactly in the same way; and this forms the whole 
treatment of so formidable a disease, and I venture to say, 
nothing the physician will have it in his power to do in his pro- 
fession, will yield him more satisfactory results. But in many 
cases, these remedies will be either delayed, or used ineffi- 
ciently, or perhaps the case may prove more untractable than 
I have supposed. The fever may continue and the inflamma- 
tion of the parts be kept up. These require a continuance of 
the depleting remedies so often recommended for the relief of 
inflammation. I should, for instance, prescribe antimonial 
mixtures to be given once in three or four hours, but not in do- 
ses to operate too much. Other mild and cooling remedies 
may be used according to the symptoms of the case. Where 
the tumefaction of the abdomen is great, warm fomentations 
may be used. This would appear, in some degree inconsis- 
tent with other remedies which have been recommended. I 
have tried cooling applications in these cases, and unless I 
have been deceived, they have been productive of an increase 
of pain. Warm applications, on the contrary, have always 
appeared to afford relief. If the distension of the abdomen is 
considerable after the cathartic has operated freely, have a 
large warm poultice enclosed in a bag, and kept warm on the 
abdomen. These remedies maybe used as the strength of the 
patient and the violence of the disease seem to demand, till 
there seems to be no farther use for them. 



640 MILK LEG. 

MILK LEG. 

This disease is said to consist in an inflammation of the veins 
of the womb, extending from that organ to the veins of the leg. 
It produces a painful swelling very much like that produced in 
dropsy, the leg and thigh having a shining appearance, and in 
the parts which are not too tender to admit of being pressed, 
leaving for a time the marks of the fingers as if the impression 
had been made on dough. The attack of this disease is com- 
monly with more or less chill, followed by a low degree of fe- 
ver — lameness and pain in the limb. Professor Meigs has 
stated that the pain and soreness are almost always felt first in 
the calf of the leg. I had thought this pain related more to the 
veins which pass on the inside of the knee down the leg. This 
affection of the leg, enables us, from the first, to distinguish this 
disease from puerperal fever. It is a great relief to the mind 
to discover, that it is in fact a case of milk leg .; for this is com- 
paratively a disease of little danger. It is sometimes, how- 
ever, equally painful, and often a great deal more obstinate and 
lasting. I have known it to be fatal in only a single instance. 
The injury done to the veins of the limb, is seldom entirely re- 
covered from : the persons who have once had it, have always 
some degree of tenderness and lameness along the course of 
the leg, which has been affected. In a few cases, both legs are 
equally affected at the same time. The situation of the suf- 
ferer is one of entire helplessness : she is unable even to turn 
in her bed. 

TREATMENT. 

Bleeding and the application of warm poultices form about 
the whole of the treatment recommended for this affection. In 
the commencement of the disease, where it is in any degree 
violent, the drawing of blood may be necessary. I have sel- 
dom met with cases, in which I thought it necessary to resort 
to this remedy; but I think it unsafe to forbear the use of ca- 
thartic remedies. It is true they are inconvenient in conse- 
quence of the helplessness of the patient ; but they should by 
no means be neglected. A full dose of calomel should be ad- 
ministered, followed if necessary by a Seidlitz powder, or a 
small portion of castor oil. At the same time warm poultices 
should be applied along the course of the limb, and across the 
abdomen, for the pain will be often found to extend into the 
lower part of the abdomen, near the hips. Several poultices 
should be made and put into bags for this purpose ; and they 



MILIARIA. 641 

should be applied as hot as the patient can endure them ; and 
it will be soon found that she will demand them of as much 
heat as the nurse will willingly handle them herself. If the 
pain is very great, a dose of morphine or laudanum, may be 
given as soon as the cathartic has operated. Although this dis- 
ease is an inflammation tending to suppuration, there can be no 
doubt of the great superiority of the hot applications in the 
treatment of it ; and it is to the application of heat principally 
that the patient is to look for relief from the most agonizing 
pain. In addition to this her position should be perfectly hori- 
zontal, and as easy as it can be made. It should be so arrang- 
ed that the limb can be more or less bent, and the patient should 
be allowed to choose her own position. When the disease sub- 
sides, and the tenderness of the limb admits of the application 
of a bandage, a roller of five or six yards in length, should be 
applied from the toes, running up with uniform, but moderate 
pressure over the leg and thigh. This bandage is an important 
item in the treatment of this disease. It should be carefully 
attended to, and not allowed to produce pain, and yet so used 
as to afford some support to the weak vessels of the limb. Re- 
coveries under its use are a great deal more perfect, than those 
which are allowed to take place without it. It should be care- 
fully applied once a day at first, and afterwards not so often. 
The application should not be discontinued when the patient is 
able to rise from her bed. She should be taught to have it ap- 
plied by the assistance of a nurse, and not abandon it as long 
as she finds it useful. In some instances the pain of this dis- 
ease comes on in paroxysms and is so severe as to be intolera- 
ble. In such cases a dose of laudanum twice a day and hot 
applications diligently made have answered all my expecta- 
tions. I have never seen suppuration result from this treat- 
ment. 



M ILIARIA— SUDAMINA. 

This slight affection would not call for any notice, were it 
not that it sometimes produces a degree of fear and uneasiness, 
far beyond its importance. Perspiration seems to be one of 
nature's means of throwing off the superabundance of fluid 
from the child-bed woman. This perspiration is sometimes in ex- 
cess, and becomes, of itself, a cause ot great exhaustion. After 
it has continued for a number of days, and without any other 
cause that we are apprised of, the patient will be affected with 
41 



I 



642 FLOODING. 

a certain degree of itching on the skin. On examination it will 
be found covered with minute blisters, which are compared to 
the seeds ofthe millet, and have thus given name to the disorder. 
These vesicles are colorless, and the. skin, if not minutely ex- 
amined, would not appear to be in the least changed. The 
slightest pressure, or scratching of the part, will cause them to 
burst, and the matter which they contain, which, I have no 
doubt, is mere perspirable matter, flows off. Thus far the dis- 
ease appears to be perfectly trivial, and is, in many instances, 
not regarded by the patient. But in some instances a degree 
of excitement now takes place, and a light inflammation spreads 
over the skin producing redness. The skin itself appears to 
be thickened, and the patient feels that she is feverish and dis- 
eased. Now these disorders do not call for any additional 
medical treatment beyond that which would be proper if they 
had no existence. A blue pill followed by a Seidlitz powder, 
frictions on the skin, and dry clothing frequently renewed, form 
all the remedies which I think it necessary to suggest on this 
occasion. The only thing, which I consider of much impor- 
tance in the matter, is that the mother should be informed, that 
these are symptoms of no particular danger. 



FLOODING. 

Under this title 1 propose to treat hemorrhage from the womb, 
under a particular state of circumstances. Every woman is ap- 
prised of the great danger which attends flooding. When it 
occurs immediately before or after delivery, they are apprised 
that life is at stake ; and that there is but little time to look for 
remedies, or send for physicians. A knowledge of the most 
proper measures to be taken at such a moment, is therefore 
very important. The measures which might be taken by a 
skilful surgeon, in cases of great extremity, can hardly be re- 
commended in a work like this. I shall mention only the meas- 
ures that are practicable and useful in common hands. 

If the discharge of blood precedes the delivery, it is obvious 
that every means to forward the delivery should be used. In 
many instances, a dangerous flooding is suppressed by the ef- 
fect of a single powerful pain, which brings down the child to 
a lower position, where from its pressure on the blood vessels 
concerned, the hemorrhage is instantly arrested. If the labor 
has been long protracted, and hemorrhage comes on, no time 
should be lost in administering ergot. Ten grains may be giv- 



GIVING SUCK. 643 

en every fifteen minutes till three or four doses arc given. Se- 
vere labor pains may be expected to arise from the use of this 
article, and the hemorrhage will either be arrested, or the labor 
brouqht to a termination in a short time. There are other in- 
stances in which the hemorrhage comes on after the delivery. 
In these cases, perhaps, in half an hour after the child is de- 
livered, the mother will be seen to faint; and, on examination, 
it will be found, that there is a rapid and incessant flow of 
blood. From forty to sixty drops of laudanum should be in- 
stantly administered, and five grains of sugar of lead as soon 
thereafter as possible. Frictions over the abdomen, with the 
hands of assistants, should be at the same time applied, and 
the hand of the midwife introduced, if necessary, into the 
womb, to stimulate it into more powerful contractions ; for 
these contractions when brought about, suppress the hemor- 
rhage in nature's own successful way. In addition to this, 
cold applications may be used, taking care that they are not 
continued when the patient is so weak and exhausted, that the 
mere application of cold might be fatal. Stillness and a hori- 
zontal position should be observed strictly in these cases. Great 
pains should, at the same time, be taken to sustain the spirits 
of the patient ; for, from some unexplained law of nature, the 
influence of fear, however excited, tends to promote a violent 
action in the vessels of the womb. In some instances the 
womb seems to fail in contracting to smaller dimensions, on the 
delivery of the child. Indeed this, id a greater or less degree, 
is the cause of hemorrhage of this description. Considerable 
assistance may be given to the feeble powers of nature by pres- 
sure on the part, either by the use of bandages, or by the hands 
of a friend. In many instances the walls of the abdomen are 
so thin, and lax at this time, that they are easily taken up by 
the hands; and the womb, when it fails to contract, is taken 
up at the same time. A strong pressure between the hands of 
an individual kept up for only a few minutes, has in many in- 
stances, I have no doubt, arrested, what would otherwise have 
produced a fatal hemorrhage. A thing so important and so 
easily accomplished ought to be known at the bed side of eve- 
ry individual in this situation. 



GIVING SUCK— LACTATIOxN. 

One of the most interesting laws of nature, is that which 
imposes on the mother the necessity of yielding food to the 



644 DISEASES OF THE BREAST. 

child. This function, when it is perfect, should yield the child 
the principal food that it is to use for the first year of its exis- 
tence. In a healthy female, the quantity is commonly in due 
proportion to the wants of the child. Sometimes, however, it 
is too abundant ; and in other instances, too small in quantity. 
When it is too abundant, it is only necessary to allow the 
child to draw from first one breast and then the other, the 
quantity it requires, and if possible to avoid drawing from the 
breast any thing more. This may be somewhat painful, for 
the breast will be constantly distended ; but the effect of it 
will soon be seen to produce a less abundant secretion of milk, 
and to reduce the quantity sufficiently. Should pain, and 
symptoms of inflammation attend this attempt, it will be ne- 
cessary to procure the aid of another to draw, from time to 
time, a portion of the milk, still remembering never to draw 
the breasts entirely empty, for emptying the breast is the best 
means of promoting the secretion of more. In the instances in 
which the secretion is too small in quantity, it may be increased 
by the reverse of the above rule. Let the breasts be drawn as 
frequently as possible ; and when drawn, let all that can be ta- 
ken from them, be abstracted. This will promote the secre- 
tion in a wonderful degree, and in many instances, where it is 
done with assiduity, supply to the child food in abundance. 
Where this proves insufficient, warm applications in the form 
of poultices around the breast, have been used with benefit. A 
generous food of fluid aliment will also promote the same end. 



DISEASES OF THE BREAST. 

INFLAMED NIFPLE. 

This is a very common disorder in mothers with their first 
children. In early marriages, the nipple is frequently very 
imperfectly developed at the birth of the child. Very great 
straining therefore of the skin is produced by the attempt of 
the infant to suck, which soon produces a very great degree of 
tenderness and pain at the time. Very commonly this pain 
extends up into the breast, alarms the mother, and she is told 
that the sucking must be repeated as often as possible, for fear 
the breast may inflame and suppurate. This is bad policy. 
A nipple inflamed, is to be treated as any other inflammation. 
The drawing of the milk from the breast is a matter, of absolute 



DISEASES OF THE BREAST. 



645 



necessity ; but it should not be performed too often — once in 
six hours is often enough. As soon as the drawing of the milk 
by the infant is effected, the nipple ma}' be wet in alum water, 
and then allowed to dry ; and it should be kept as dry as pos- 
sible. By this means, the skin is hardened against the next 
time it is to be drawn ; and, in many instances, all ill effects 
hindered. But we are not always so fortunate as to see this 
disorder arrested at such a crisis. Cracks form, which grow 
deeper and deeper ; and, many a time, are attended with a 
loss of the nipple itself. These cracks are scarcely the object 
of different treatment. When they become deep, sometimes 
it may be well to touch them with a lunar caustic ; but, in 
general, the treatment recommended above, of washing them 
in alum water, or a decoction of red oak bark, or any astrin- 
gent in common use, answers every purpose. 

INFLAMMATION OF THE BREAST. 

The milk vessels which should form a system of tubes, dis- 
charging without interruption at the nipple, are frequently hin- 
dered in the performance of this function ; and this very often 
gives rise to inflammation of the breast, and suppuration. 
When this inflammation first occurs, it is commonly obviously 
connected with one particular part of the breast, in which a 
tumor or knot, as it is commonly called, is first felt. This tu- 
mor is manifestly a mere collection of milk ; and sometimes 
when, with a little care, the inflammation is not aggravated, 
and the milk has accumulated as much as the dimension of the 
vessels will admit of, it suddenly bursts forth and spins out un- 
til it is thoroughly discharged, and a threatened disease is dis- 
posed of in a moment. Every effort should be made to bring 
about this desirable result. The child should from time to 
time be applied to the breast, and allowed to draw it ; and 
when a flow of the milk is not thus procured, cooling applica- 
tions should be made. The mother should, in the meantime 
remain as still as possible ; and, after due time, the attempt 
should be repeated. But in spite of all the prudence and man- 
agement that can be used, these cases sometimes go on to the 
production of matter. This is a painful result ; but I know of 
no better way in such cases, than to allow the matter to be 'ful- 
ly formed, and to open and discharge it with a lancet, taking 
care that the cut shall be in the direction from the nipple to the 
mother's body, so that the milk vessels which are not yet di- 
vided may be preserved. These suppurations are sometimes 



646 VENEREAL DISEASE. 

superficial; and when the matter is discharged, the cure is 
perfect, leaving the breast to yield milk as well as before. But 
there are many instances, in which an incurable disorder of 
the. breast, is brought about ; and our only resource is to cause 
the milk of the organ to be dried up. It is an easy matter to 
dry up one of the breasts, and still to retain the other in a situ- 
ation to yield milk. To do this, it is only necessary to cease 
to abstract the milk which is formed in it. As soon as it be- 
comes painful, draw from it a small portion, taking care never 
to draw it empty, and to protract the times of drawing, and to 
lessen the quantity drawn until it becomes no longer necessary 
to draw from it any at all. It is wholly unnecessary to apply 
washes, poultices, blisters, plasters, or any thing of the kind. 
They are useless. 

It should not be forgotten, that the breast in the state to form 
milk, is enlarged, and the vessels much strained when it is full. 
The weight of the organ is a serious inconvenience ; and often, 
from movements by no means violent, becomes a cause of 
bruises and ruptured vessels. Great care should therefore be 
taken to support the breast by well adjusted clothing, which 
should operate as a support. This is the more necessary, 
when the female goes abroad, either to ride or to walk. The 
inflammations which follow such excursions, are charged to 
catching cold ; but they are almost always chargeable to the 
weight of an unsupported breast. 



VENEREAL DISEASE. 

It is not without some hesitation, that I have consented to 
treat of this loathsome disease ; but the reasons requiring it, 
are so strong, that I have thought it necessary to give way to 
them. This disorder, or rather these disorders, for there are 
two varieties, were not known to the ancients. It is about 
three hundred years, since it was first described as a conta- 
gious disorder. Its spread in the South of Europe, was rapid 
and alarming. During more than half a century, no remedy- 
was discovered for it. The mortality which was attributed 
to it, compares with the worst plagues that ever visited the 
world. I have seen the deaths which it caused in fifty years, 
estimated at fifty millions of people. It prevailed principally in 
the South of Europe, at that time the most civilized portion of 
the world, and such was the alarm inspired by it, that great 



VENEREAL DISEASE. 647 

fears were entertained of an entire destruction of the human 
race. Medicine lias accomplished no other triumph equal to 
the arrest of this formidable disease. It is no longer a scourge 
to those who by a purity of life, are entitled to an exemption 
from its effects ; and under the worst circumstances, it excites 
but little fear, and is commonly brought to a speedy and 
successful termination. It still exists, however, in sufficient 
frequency to be a just cause of alarm to those who might wish 
to practice illicit indulgence. 

OX THE CONTAGION OF VENEREAL DISEASES. 

Since the days of the celebrated John Hunter, it has been a 
dispute whether there were, in fact, two venereal diseases, or 
but one. That able writer performed many experiments Lo 
decide this point, and came to the conclusion, that all the dis- 
eases now known. under this title, are varieties of one infec- 
tion. The varieties, however, differ so widely, that without 
intending to become a partisan on either side of the question, 
I shall treat them separately, and give to each its appropriate 
description and remedies. They are, however, both contagi- 
ous, and the manner of their propagation by the intercourse of 
the sexes, is the same, each producing in the first instance a lo- 
cal disorder, which may finally spread to distant organs. It 
was formerly believed that the infection was so strong, that it 
was dangerous to come into the presence of one having this 
disease. It became therefore, a custom for one who was un- 
fortunately so affected, to mention his condition, and to sub- 
mit to a voluntary banishment from society, which doomed 
him in many instances, to a miserable death like a wild beast 
in the woods. Holy abbots, who were thought to have been 
infected by their visits to the sick, we are told, were seen to 
take leave of their congregations under these appalling circum- 
stances. The manners of that age, required reform ; and I 
will not withhold the opinion, that the fear of this disease has 
been one of the powerful restraints which has curbed the li- 
centiousness of nations. The propagation of this disease is a 
mere inoculation. The infectious matter being laid on or ap- 
plied to a moist or mucous membrane, produces there its pe- 
culiar inflammation. Inserted with a lancet into the skin, in 
the manner of inoculation for small pox, the disease is also 
propagated under certain circumstances to which I have not 
time to advert. The most common mode of its propagation, 
is by the intercourse of the sexes ; but there are not wanting 



648 VENEREAL DISEASE. 

cases of its spread by the mere act of kissing, or any mode of 
applying the infectious matter to the moist surface either of 
the eye, the nostril, the mouth, or the anus, or neighboring or- 
gans. It is important that individuals affected with this dis- 
ease, should know the laws of its propagation, and thus be 
enabled to avoid communicating it. The infection in the two 
varieties of the disease, requires a separate consideration. 
The most infectious of the two, is the common gonorrhoea or 
clap. It is met with, in nineteen out of twenty cases of vene- 
real diseases. It is propagated almost exclusively by the in- 
tercourse of the sexes. When the disease first makes its ap- 
pearance, it is most infectious ; after it has continued a great 
length of time, it ceases to be infectious, without, so great a 
change in the appearance of the discharge as might seem to 
account for it. No rule that I know of can be given for the ab- 
solute decision of the question, whether the disorder is in an 
infectious state or not. It seldom continues so, as much as 
twelve months, however ill or inefficient the treatment may 
have been. I should say that if it had continued during a 
shorter time, with obvious proofs of its presence, all the while, 
there would be danger of its propagation. There is some con- 
solation, however, in knowing, that although, in some cases, 
this species of infection continues in a mild form for a great 
length of time, it is at length, free from infection. The syphilis 
or pox, is infectious only during the existence of the ulcer, or 
vesicle, in which it makes its first appearance. This ulcer is, 
in many instances, so trivial as to excite not attention. It is 
then in its most infectious state. It seldom gets well of itself, 
but is easily destroyed, and heals up, after which, the indi- 
vidual on whom it has been, is incapable of propagating it to 
others. He is far, however, from being relieved of the dis- 
ease ; not only is he thoroughly affected by it, but it may take 
months and even years to rid him of it ; still during the whole 
of this time, however loathsome the symptoms which may ap- 
pear, they are incapable of being propagated either by contact 
or otherwise. One exception, however, in reverence to high 
authority, I am bound to mention ; it is said, that persons thus 
affected, although they can not by any means propagate it to 
others, leave it as an inheritance to their offspring, in whom it 
may appear soon after birth, or at any time in a long life there- 
after. I confess that I am not a full believer in this doctrine. 
It is a subject of deep interest, and has been investigated with 
much labor and research. The disorder most resembling the 
secondary, or as these cases are termed, tertiary symptoms of 



SYPHILIS OR POX. 649 

syphilis, is scrofula ; and persons affected with this disease, 
are many times, thought to labor under syphilis. Now from 
my own observation, I am obliged to believe, that in general, 
the disease which has in these cases been termed syphilis, is 
an original attack of scrofula. The last publication which I 
have seen on this subject, is by Ricord, who in a Parisian hos- 
pital, had every means of information. He is a believer in 
the transmission of venereal infection ; but says, that it never 
appears without complication with some other disorder ; that 
the venereal disease alone never appears as a transmitted 
disease from parent to offspring. Now, this is so near a giving 
up of the whole question, that it seems to me there is little left 
to dispute on. Living as I do, in a country in which scrofula 
is comparatively a rare disorder, I have had very few reasons 
to believe, that I have seen a transmitted syphilis, and my 
mind is strongly inclined to the belief, that there has been an 
error on this subject, which it is important to correct. 



SYPHILIS OR POX. 

This disease is almost always produced by impure coition. 
It makes its appearance within from eight days to six weeks 
of the time at which it was contracted. Its first symptom is 
a chancre or small and commonly insignificant vesicle on the 
organs of generation, sometimes in the tender skin, near the 
mucous surface where there is a perpetual state of moisture, 
but in many instances at some distance from these parts. At 
first it is a mere watery blister not larger than the head of a 
pin. In a day some degree of inflammation at its base will be 
found, and an increase of size will be constantly perceived. In 
a few days it will present a whitish appearance, with perhaps 
the skin broken or rubbed off, and the whole base will have a 
hardened or thickened appearance. The matter which flows 
from it will be very small in quantity and perfectly transparent. 
So small, indeed, is the discharge, that the disease has obtained 
the common name of dry pox. In this state the disease gradu- 
ally advances till the chancre is healed by proper applications. 
In other instances the ulcer produced by this disease is widely 
different. It assumes a ragged, spongy appearance, becomes 
deep and wider at the bottom than at the top, destroying the 
parts affected with great rapidity, and many times producing 
fearful mutilations. There are still other cases in which the 



650 SYPHILIS OR POX. 

symptoms are more formidable, producing mortification and 
sloughing to the entire destruction of the organs affected. 
These symptoms constitute what has been termed the first 
stage of syphilis. The second stage makes its appearance in 
the form of bubo, which is an inflammation of the glands of the 
groin, sometimes occurring on one, and at other times on both 
sides. The progress of this inflammation is slow. The glands 
affected are sometimes superficial, and at other times deeper 
seated ; for there are many lymphatic glands in this particular 
region. The pain which attends it, is less than the amount of 
swelling and the appearance of inflammation, would seem to 
indicate; still it goes on, if not arrested by remedies, to a full 
suppuration, when the skin bursts, disclosing a foul and un- 
tractable ulcer. The ulcers thus produced give way only un- 
der a proper constitutional treatment for the disease. The mat- 
ter which flows from them is said to be, in some cases, infec- 
tious, and in others not. The third stage of the disease has 
the great characteristic of • being totally free from infection. 
Many ulcers arise in it, producing the discharge of matter 
which would lead to its propagation in various ways; but it is 
a question well decided that this matter is not infectious. The 
symptoms of this stage of the disease are called secondary. 
They affect almost all parts of the body, the skin, the throat, 
the bones, and the cartilages, but, so far as I know, the more 
vital parts of the body, the brain, the lungs, and the intestines 
are free from its attacks. Commonly these symptoms do not 
appear in less than six weeks from the commencement of the 
disease. They are many times much later in making their ap- 
pearance, and what length of time we shall say is the period 
at which the individual, who has been thus affected, may feel 
himself entirely free from the danger of these secondary symp- 
toms, has not been yet decided. Commonly this stage of the 
disease appears with ulcers in the throat. On opening the 
mouth and pressing down the tongue, there will be seen in the 
back of the throat, an ulceration, deep and ragged, as if a por- 
tion of flesh had been du^ out with a small chisel. These ul- 
cers are so insensible, that the person affected by them is not 
commonly apprised of their existence until they have acquired 
a considerable size. The next symptom which has been ob- 
served is an eruption on the skin. . This may appear on any 
part of the body and result in ulceration, producing scabs with 
a peculiar copper color seen in no other disease. Another 
symptom very common at the same time, is a diseased state of 
the bones. The hardest plate of bone in the body seems to be 



SYPHILIS OR POX. 



651 



most liable to this affection; The shin bone I have seen more 
frequently affected than any other. The bones of the head are 
also subject to these attacks, and 1 have seen instances ill 
which, a caries of these has resulted in a loss of a large por- 
tion of the skull, exposing the brain almost naked to view. 
Great pain attends this stage of the disease. This pain very 
much resembles rheumatism. It is much worse at night, and 
productive of more distress than any other symptom of the 
disease. These are the leading features of pox, from the be- 
ginning to the end ; if not arrested by proper remedies they go 
on almost invariably to the destruction of the patient. 

REMEDIES FOR POX. 

The first object to be had in view is the healing of the chan- 
cre, or original ulcer. This chancre will sometimes be found 
to have healed of itself. In several instances I have met the 
disease in a state of bubo, the individual declaring that he had 
never had any thing like a chancre. If the chancre exists, 
however, it is the first object of treatment, and the remedy is 
an application of lunar caustic. This should be made very ef- 
fectually. The caustic should be moistened and rubbed on the 
whole of the part affected for about a minute. The operation 
will be somewhat painful, and if a considerable inflammation 
follows it, a soft poultice of corn mush or light bread, boiled in 
water or milk, should be applied. If the inflammation is con- 
siderable great care should be taken that the individual is ab- 
solutely at rest. In addition to this if there appears any dan- 
ger from the inflammation, an active cathartic should be taken. 
Where the ulcer puts on a different appearance from that which 
we have described as a common chancre, there is much more 
difficulty in the treatment. Even here I am decidedly in favor 
of the absolute destruction of the sore by lunar caustic, but 
the inflammation which sometimes follows this is very severe, 
and may endanger the mortification of some portion of the sur- 
rounding substance. These cases ought always to be placed 
in the hands of an experienced surgeon. They are decidedly 
dangerous. After the cauterization of these ulcers, they are to 
be treated with the mildest applications. Lint should be ap- 
plied to them, and over this, a covering of fine rag kept con- 
stantly moist with water. If the case is not alarming, and 
this treatment is found inconvenient, a plaster of simple oint- 
ment may be substituted. If the symptoms are free from dan- 
gerous inflammation, no time should be lost in commencing the 



652 syphtlis or pox. 

internal use of mercury. If any inflammation which threatens 
gangrene is present, this is first to be subdued or very much 
lessened ; but this also will in the end require the same use of 
mercurial remedies. In combination with mercury it is, how- 
ever, advantageous to use opium, not only on account of its al- 
laying pain and irritation, but because it hinders the action of 
mercurial remedies on the bowels, by which means they are 
often thrown off and prove ineffectual. I have also used pills 
composed of calomel and opium. Take of calomel twenty 
grains, opium five grains : mix and make into sixteen pills. Of 
these pills two a day may be taken, and if they do not produce 
symptoms of salivation, they are to be continued till the whole 
are taken. It is desirable that a low degree of salivation should 
take place. Writers assure us that the cases in which no sali- 
vation occurs, get well as readily as those in which it does; but 
I never was able to satisfy myself that a proper degree of mer- 
curial action had taken place without some degree of salivation 
being present. Still I have found cases in which I was wholly 
unable to excite the slightest appearance of salivation, and } r et 
these cases have recovered under the use of mercury as readi- 
ly as others. More frequently, however, when the sensible ef- 
fects of the remedy are not seen, we are apt to be disappointed 
in our expectation: the cure is either greatly postponed or not 
effected at all. These remedies, mercury and opium, are the 
sole reliance in the treatment of the constitutional symptoms of 
syphilis. Books have been written to decry mercury, and to 
declare that there was no necessity for its use ; but I believe 
experience has at last settled the question permanently. No 
prudent physician dares to withhold this remedy from his pa- 
tient. It is unnecessary to add a great deal in reference to the 
treatment of cases which become protracted, and produce the 
several symptoms which have been referred to above. Mer- 
cury and opium are the only remedies which remove the dis- 
ease. The opium should be used from time to time according 
to the necessities of the case. It should be used to allay pain, 
to arrest disorders of the bowels, or to remove the irritable 
state of the nervous system, which so commonly occurs in pro- 
tracted cases ; but the use of mercury should not be too long 
protracted at one time. A slight salivation being brought on, 
should be kept up for five or six weeks, when the remedy 
should be laid aside. It should be suspended for a time, al- 
though the symptoms of the disease may not seem to be bene- 
fitted ; for it seems that where the system has been mercurial- 
ized for a great length of time, the remedy is no longer efficient 



SYPHILIS OR POX. 653 

for the removal of the disease. It should be laid aside for a 
time when it may be again resumed with every prospect of as 
much benefit as in the first instance. There may not be want- 
ing cases which will prove untractable under these remedies* 
There are many other nostrums which have been advised in 
such cases ; I have but little faith in any of them When the 
patient is much reduced by prostrating courses of mercury or 
any thing else, a generous diet and other restorative means 
should be allowed him. He may also take such tonic medi- 
cines, as experience has proved to be qualified to restore the 
strength. He may visit watering places, especially where there 
are warm springs, with great advantage, and if he has rheu- 
matic pains he will be much benefitted by the common reme- 
dies for rheumatic disease ; but if these pains arise from syphi- 
lis, he will not be permanently relieved of them until he re- 
turns again to these mercurial remedies. 1 will not enter into 
the dispute over the many ills which are charged to the use of 
mercury : I have neither room nor inclination for it. I have no 
hesitation in regard to the advice 1 have given. I face in it all 
the responsibility which may attach to me in the premises. 

It may be wrong to say nothing of other preparations of mer- 
cury in the treatment of syphilis. In combination with iodine, 
it is thought to be more efficient than when used alone. The 
hydriodate of potash is a chemical compound of these reme- 
dies which is now much used. I have no doubt of the great 
value of this preparation. It may be given in doses of from 
two to five grains twice a day. The corrosive sublimate 
is another preparation of great value, especially when the dis- 
ease attacks the skin with a general eruption. It may be given 
in doses of from a quarter to half a grain, two or three times a 
day. All these remedies may be used alternate^ as they shall 
be found most beneficial in these tedious cases. 

GONORRHOEA OR CLAP. 

This affection is contracted in the same manner we have de- 
scribed for pox. It usually makes its appearance in from four 
to eight days after it is contracted. There are instances of its 
appearing, however, in a single day, and others in which it has 
appeared after three weeks. This disease consists in an inflam- 
mation of the urethra in men, and of various parts of the mu- 
cous surfaces of females. It makes its appearance by some 
excitement and itching of the parts, followed by an inclination 
to discharge urine frequently, and after a day the discharge of 



654 GONORRHOEA IN MEN. 

mucous matter which is of a greenish yellow color. The in- 
flammation will by this time have become considerable. The 
parts will have acquired some redness, and a degree of tender- 
ness. Without much variation, these symptoms continue, the in- 
flammation in men not extending more than an inch from the 
opening of the urethra. After a considerable length of time, 
however, it will be found to have progressed along the urethra, 
and to produce particular excitement very near the bladder. 
In females the whole vagina is frequently affected. This dis- 
order is much more formidable in men than in women. 



GONORRHOEA IN MEN. 

We have seen that this disease produces in both sexes, an 
inflammation of some portion of the organs of generation. As 
the disorder progresses, the symptoms it produces differ so 
w r idely in the different sexes, that it becomes necessary to 
treat of them separately. In men the inflammation frequent- 
ly continues for many weeks or months, without progressing 
along the urethra more than an inch. From this point it ap- 
pears to move on at once, and to establish itself in the urethra 
near the neck of the bladder. The symptoms which follow, 
are much more formidable. The bladder itself is frequently 
involved, and the prostrate gland and the parts near it, are 
frequently also involved. The symptoms become much more 
alarming. Frequently a very large discharge of purifbrm mat- 
ter takes place, with all the spmptoms of a much more extend- 
ed and violent disorder. In other cases the disease seems to 
be transferred to the testicle, and suddenly a pain and swel- 
ling will attack one of these organs. The discharge from the 
urethra will suddenly disappear, and the swelling of the tes- 
ticle progress with great rapidity and pain. In a day or two 
this organ is enlarged to three or four times its natural size. 
The pain is in proportion to the rapidity of the swelling, and is 
sometimes excruciating. In other instances, the inflammation 
seems to be transferred to the glands of the groins, producing 
buboes, very much resembling those which are produced by 
syphilis. This is however a rare occurrence, and such buboes 
have never within my observation suppurated. After these 
symptoms have continued for some months, the disease some- 
times appears to assume a constitutional form. The health of 
the patient is destroyed, and I think I have witnessed an in- 



GONORRHOEA IN MEN. 655 

stance in which death occurred from a protracted venereal 
inflammation of the prostrate gland and of the bladder. 

TREATMENT OF GONORRHOEA IN MEN. 

For the disease in its first stage we have two remedies, 
which are so far superior to others, as to be solely entitled to 
notice here. These remedies are balsam copaiva, and cubebs. 
We are charged by some not to use these articles when there 
is present an active state of inflammation, but to precede them 
by the use of active cathartics, bloodletting, leeching, cold ap- 
plications, and other antiphlogistic remedies. Others advise 
us to use the balsam copaiva without delay, whatever degree 
of inflammation and fever may attend the case. This is my 
own practice, and I will remark, that 1 have never met with a 
degree of lever and inflammation in this disease to cause me 
to hesitate for a single moment. So long as the disease is con- 
fined to the urethra, whether it be near its external orifice, or 
near the bladder, 1 have no hesitation in the remedy I shall 
use. The patient should take a tea spoonful of balsam copai- 
va twice or three times a day. This is a measure of about a 
drachm and a half at a dose, and very small in proportion to 
what some have recommended, but much larger than what 
others of equal authority would tolerate. The relief which 
this remedy will afford, will be perceived almost immediately, 
perhaps in a few hours. A pretty copious secretion from the 
kidneys, will take place, and a flow of limpid urine follow it. 
In some cases it operates on the bowels as a cathartic, and in 
a great many instances, becomes exceedingly loathsome to the 
patient. Many contrivances have been made to remove these 
inconveniences. Capsules containing the copaiva, are in dai- 
ly use. The objection to them is, that it takes a great many 
of them to contain the requisite quantity. After all the meth- 
ods which [ have seen advised lor the administration of this 
remedy, I know of no better, than to pour it on a little clear 
water in a wine glass, and turn it up to the mouth andswallow r 
it. But the mode of taking the article, is a matter of little con- 
sequence — the quantity which should be taken is the maiu 
thing. This quantity is to be regulated more by the power of 
the patient to endure it, than anything else. It may be carried 
up to an ounce a day, and when the stomach will bear it, and 
it produces no great effect as a cathartic, the relief obtained 
by it, will be in proportion to the quantity used. This reme- 
dy is to be continued till the discharge disappears, and for ma- 



656 GONORRHOEA IN MEN. 

ny clays afterwards. The great difficulty is, that after the dis- 
ease has disappeared, and the patient considers himself well, 
it will frequently return again. In these cases, we know of no 
better remedy, than to return to the use of the balsam. 

The next remedy in point of value, is cubebs, and its effects 
are so similar, that in many instances, the patient will be scarce- 
ly able to tell which of the articles he had taken, from the effect 
produced. The advantages of this article, are, that it is less 
loathsome, and does not disagree with the bowels, and pro- 
duce pain as the balsam does. It may be given in powder, in 
doses of thirty grains from three to six times a day. It is often 
given at the same time with the balsam, by lessening the dose 
of that article, and giving a portion of cubebs. This course I 
have known to. succeed when no other article alone seemed to 
answer. In some instances where the secretion of urine is 
small, it is advantageous to unite with the balsam an equal 
quantity of spirits of nitre, and where there is a good deal of 
internal pain, a portion of laudanum so graduated as to yield 
to the patient from forty to sixty drops in twenty-four hours, 
may be beneficially added. All these remedies, although they 
exert a very great control over gonorrhoea, are sometimes used 
for a very great length of time without effecting a cure. The 
average of time which it will require to effect a cure, will be 
about three weeks. One half of the cases probably require 
twice that length of time, and not a few will baffle us longer 
still. When the disease has left the urethra and attacked 
neighboring organs, we can no longer rely on the cubebs, and 
balsam for relief. These remedies seem to effect no good, 
where the disease is a swelled testicle, or inflammation of the 
glands of the groin. These affections are to be treated as a 
mere inflammation. The fever which attends them, is many 
times very considerable, and the remedies to be used are such, 
as are suited to the same degree of inflammatory disease. In 
these instances, an emetic of antimonial mixture should be given. 
It should be given 'to act promptly and effectually. Where the 
disease is a swelled testicle, warm fomentations to the part, 
should be used ; and here let me remark, that although there is 
great heat in this organ, there is no tendency to suppuration, 
and although from the pulse, cold applications would seem to 
be best, they are uniformly hurtful, and produce an aggrava- 
tion of the disease, while warm applications afford the great- 
est relief from pain, and benefit to the patient. These reme- 
dies, when judiciously applied, will be found sufficient for the 
removal of these symptoms of gonorrhoea ; but when the pros- 



GONORRHOEA IN MEN. 6^7 

trate gland is affected, the case is much more serious, for this 
organ when affected with inflammation from any cause, seems 
less capable of recovery, than almost any other. It is in cases 
like these, that we are recommended to use the internal and 
alterative remedies, which are used in syphilis. Mercury in 
broken doses, or iodide of potassium used in the same way. I 
know nothing better to offer in the treatment of these cases ; 
but I feel bound to state, that their effects have proved very 
unsatisfactory in my hands. In addition to all these remedies, 
when the disorder is protracted, and the discharge becomes 
thin and almost colorless, or rather whitish than yellow, in- 
jections have been recommended. They should be astringent 
in their qualities. The most common is composed of sugar of 
lead and white vitriol ; ten grains of each dissolved in half a 
pint of water, and suffered to stand till perfectly transparent, 
when it is to be poured off, and used as an injection. This is 
one of the many astringent injections which have been pro- 
posed for the cure of gonorrhoea. A decoction of oak bark, 
brought to a deep straw color, is a good remedy of this class. 
Where there is much scalding or pain at the discharge of urine, 
laudanum, about twenty drops to the ounce, may be added to 
any astringent injection which may be used. 

There has lately been introduced an injection of extraordi- 
nary power, and of which I can say but little from my own 
observation. This is a solution of lunar caustic, in rain or river 
water, in which about twenty grains to the ounce is to be dis- 
solved. This powerful remedy may be safely used, and if it 
is tried, let it be used once a day for two or three days. It 
should be thrown up from a syringe, with rather a large orifice 
in its point, and pains should be taken to hinder the escape of 
the fluid for a few seconds. This remedy is said to put a sud- 
den stop to the disease, if used on its first appearance. Like 
all other stimulating injections, it exposes the patient to the 
danger of a swelled testicle, if used when the disease is in a 
state of too much excitement. Its use should not be attempt- 
ed without the advice of a physician. 

Gonorrhoea sometimes excites an inflammation over the pe- 
nis, where the skin folds over and preserves a degree of mois- 
ture. It is sometimes severe in this situation, producing ten- 
derness and redness, with a watery discharge from under the 
fold of the skin; but not the least inflammation or discharge 
from the urethra which is the common seat of gonorrhoea. We 
shall in vain enquire why it is, that the disease, in these cases, 
abandons its usual ground, and takes up another. But we are 
42 



658 GONORRHOEA IN WOMEN. 

consoled in the knowledge, that our remedy is at hand, and 
sure to afford relief. For these cases, take thirty grains of su- 
gar of lead, and four grains of corrosive sublimate, and dis- 
solve them in eight ounces of water. Bathe the part with 
this twice a day. If the part is so swollen as to hinder the ap- 
plication, a syringe may be introduced under the skin, and the 
fluid thrown in with some force. Care should be taken not to 
introduce the syringe into the urethra. By the use of this 
remedy the disease, in this form, will be speedily arrested, and 
no other remedy will be required. I have used it for thirty 
years, and never had a case of this affection to fail to give way 
to it, in six or eight days. 



GONORRHOEA IN WOMEN. 

This disease is, in women, a comparatively mild affection, 
The organs it may reach are the urethra, and the vagina, with 
all the moist mucous surface about the external orifices. The 
disease more readily attacks the urethra which, in women, is 
a short canal, yielding but little surface, and proportionably a 
small discharge of matter. It is on this account, that while, 
in females, the disease is confined to the urethra, and in its 
most infectious state, it is unnoticed by them, and propagated 
without consciousness. When the inflammation has extended 
to the surrounding parts, it becomes obvious, frequently pro- 
ducing considerable external swelling, and tenderness. When 
the vagina in its whole course becomes affected, the discharge 
is greater, and the disease is hardly distinguishable from an 
aggravated case of whites. It is no uncommon case for both 
these disorders to be present at the same time. 

The remedies for gonorrhoea in women vary according to its 
symptoms. When the urethra is principally affected, and some 
pain and burning attend the discharge of urine, balsam co- 
paiva is the great remedy. A tea spoonful of this may be ta- 
ken in water, two or three times a day. If it operates as a ca- 
thartic, give ten or fifteen drops of laudanum in each dose. If 
the balsam can not be borne by the stomach, or proves ineffi- 
cient, try cubebs. Take fifteen grains, in powder, four times a 
day. If fever and inflammation attend the disease, mild ca- 
thartics become necessary, and may be used at discretion. 
Calcined magnesia and rhubarb are the best of these. Where 
the inflammation affects the parts which are external or nearly 



SCALDS AND BURNS. 659 

so, warm poultices should be applied, and the patient should 
remain as quiet as possible. 

Injections are more useful in the treatment of gonorrhoea in 
women than in men. It is true they cannot reach the urinary 
passage, and when the disease is confined to that, they are of 
little use. But when the discharge becomes considerable, it 
may be taken for granted that the disorder has invaded the 
vagina. Strong astringent injections are then to be used. 
Many have been proposed, but I will mention only a few of 
them. Take sugar of lead and white vitriol, of each thirty 
grains — dissolve in half a pint of water, and shake it when it is 
to be used. The next I will mention is a solution of alum, a 
drachm to the pint of water. A strong decoction of red oak 
bark may be substituted. These injections may be thrown up 
with a female syringe, not introduced too far into the vagina. 
A little perseverance with these remedies, and prudence on the 
part of the patient, will commonly arrest a gonorrhoea, in wo- 
men, in a short time. Where the case is complicated with 
whites, that disease is commonly made the more obstinate. 



SCALDS AND BURNS. 

Scalds and burns are of such frequent occurrence, that they 
need no description. Every one is apprised of their painful 
nature and difficulty of cure. Their treatment should corres- 
pond with the injury ; which differs in degree from the excite- 
ment of a low degree of redness in the skin, to its absolute de- 
struction. It is on this account, that it is proper to divide the 
subject, and to treat of scalds as a distinct subject from burns. 

Scalds are produced by the application of hot water, or other 
equally hot fluid to the surface of the body. If the application 
is continued but for a moment, the burn thus inflicted, will be 
so slight, as barely to blister the skin. Where the skin has not 
been torn, such burns are readily healed ; but where, from 
suddenly tearing off the clothing, or other similar cause, large 
pieces of skin are torn off, very troublesome ulcers sometimes 
follow. The treatment of burns of this description is very sim- 
ple. As soon as possible after the accident, cloths wet with 
cold water, should be spread on the part ; and this application 
frequently renewed, should be continued until the whole of the 
blistering which is likely to occur from the burn, has taken 
place. The blisters should be carefully preserved from being 



660 SCALDS AND BURNS. 

broken. The healing of these blisters is the only remaining 
part of the treatment. Where the blister is large, it becomes 
indispensible to discharge a portion or all of the water it con- 
tains. This should be done by puncturing it with a very fine 
needle, and allowing the water gradually to escape. For a 
long time such burns were treated with the application of bats 
of carded cotton, bound to them in a way to remain perfectly 
unmoved, and this is in most instances, a very good remedy. 
Such a burn, thus bound up with a considerable thickness of 
cotton, will frequently be found at the end of four days entire- 
ly healed. Of late, this remedy is beginning to be superseded 
by a continuance of the application of cold water ; and where 
the skin is torn, I have no doubt this is the better application of 
the two. • It is very troublesome, however, for it ought by no 
means to be allowed to grow dry on the surface, because in 
this state, the cloth adheres so firmly to the burnt surface, as to 
produce great irritation, and often to convert into an untracta- 
ble ulcer, that which should have been disposed of as a mere 
blister. The oldest remedy of all is perhaps the most man- 
ageable, in most cases. This is an application of simple oint- 
ment, spread on a fine rag. This ointment should be made 
sufficiently hard to remain in the form of a plaster on the rag, 
and by no means to allow the rag to adhere to the surface of 
the scald. If the burn is extensive, this application of plasters 
should be made with small slips, and put on neatly, the edges 
running over one another as the shingles of a house, so that no 
part may at any time become naked. Under a neat dressing 
of this kind, a burn that is no worse than that we are describ- 
ing, will usually heal in one week. 

Severer burns are inflicted by the burning of clothes on the 
body, and the accidental contact w r ith fire or other hot bodies. 
Such burns are not very easily judged of, on first being seen. 
Commonly the skin will be found to have been torn ofT, and 
the flesh will look as white, in many instances, as the breast of 
a chicken. Such flesh, or skin is commonly entirely destroy- 
ed. It will have to come away by a slow process of slough- 
ing, which will render the cure tedious. Many are the nos- 
trums which have been published for the treatment of burns of 
this description ; and when such nostrums happen to be ap- 
plied to burns which have inflicted less injury, they will pass 
for having accomplished a great deal. None of them are en- 
titled to any particular respect. A burn of this description is 
a bad injury, and in proportion to its extent, dangerous. Even 
a slight burn when extended over a great part of the body, is 



SCALDS AND BURNS. 661 

said to be dangerous ; although I have never witnessed a case 
of fatal injury from such a burn. But when a great portion of 
the skin is utterly destroyed and lifeless, the patient may 
well be said to be in imminent danger. He will commonly 
be found trembling and complaining of cold, denying the usual 
pain of heat and smarting which follows a burn. The symp- 
toms of cold and shivering, with pale face and faintness, are 
dangerous in proportion to their intenseness. Burns of this 
description are to be treated with stimulating applications. 
Equal quantities of lime water and sweet-oil shaken together, 
have been applied, time out of mind. This application is a 
very good one. Bats of carded cotton should be laid on the 
part, and the sweet-oil and lime water patiently applied with a 
feather, till these bats are found to be fully wet with it. The 
bats may sometimes be more conveniently dipped into this flu- 
id, and then applied ; but they should be made sufficiently 
thick on the part, to render it certain, that the bandages which 
are to go around them, will never come in contact with the 
flesh. This remedy may not always be at hand. As a sub- 
stitute, melt hog's lard, and add to a pint of it, about two table 
spoonsful of spirits of turpentine. Stir this till it begins to grow 
cool, and acquires about the thickness of cream : apply this in 
the same way I have recommended for the sweet-oil and lime 
water. In the event that neither of these remedies can be pro- 
cured, the burn should by no means remain without dressing. 
Lard alone, applied by means of bats of cotton, may be used 
in the same way. The burn thus dressed, should remain un- 
disturbed for at least three days. Pains should be taken, that 
the bandages are put on snugly, so that they will not move ; 
and where this is difficult, from the irregularity of the parts, 
the bats of cotton should be proportionably thickened, so as to 
render it as nearly as possible certain, that the surface shall 
not be exposed. 

At the second dressing, when the bandages are removed, it 
may be found that there are parts on which the cotton adheres 
with great tenacity. No force should be used in removing these. 
Take off all that can be conveniently removed ; and such as 
adheres clip with a pair of scissors. The injury is now ready 
for a second dressing. The parts which still retain the white 
appearance, should be dressed again in the same manner. 
There will often be found around the edges, and sometimes 
over a very great proportion of the injury, parts which are less 
injured. Plasters of simple ointment should be applied over 
these, and this should be the the first part of the dressing. Af- 



662 SCALDS AND BURNS. 

ter this the bats of cotton should be applied to the parts, which 
have lost the skin, and look dead, as I have described before. 
After this, the dressings may be daily repeated. They should 
be continued with a gradual abatement of the use of lime wa- 
ter in the liniment, until the dead skin has separated. This 
will expose an ulcer of some depth, and require for the separa- 
tion a considerable length of time, sometimes three weeks. 
The putrid smell which will be a great annoyance, until the 
dead flesh is separated, will now disappear, leaving the ulcer 
to be treated according to its extent and character. Such ul- 
cers have a great disposition to throw out exuberant granula- 
tions, proud flesh as it is termed. When this flesh rises above 
the ordinary level of the skin, no healing over it will take place, 
and an ulcer of slow termination will be the consequence. To 
hinder this, a powder s of lapis calaminaris should be thickly 
spread on the surface at every dressing, from the time the dead 
matter or slough has been thrown ofL" This is most conveniently 
accomplished by putting the powder into a piece of gause or 
muslin, and sprinkling it in that way. The whole surface should 
be entirely covered at every dressing. Other and similar ap- 
plications may be used ; prepared chalk, or even starch, may 
be used in case of necessity. If in spite of this, the granula- 
tions grow too high, they are to be kept down by the occasional 
use of burnt alum. The same end may be accomplished by 
washing the part with a decoction of red-oak bark. In some 
instances these granulations spring up with a vigor and power 
of growth truly astonishing. On the skin of colored people, 
they are a great deal more exuberant. I have seen them near- 
ly an inch in length, and apparently composed of thousands of 
independent living fibres. On attempting to remove a mass of 
this kind of matter with a knife, I have in one instance found a 
hemorrhage so great as to be truly alarming. This case was 
at last controlled by applications of extract of oak bark, made 
by boiling a quantity of strong decoction down to the consis- 
tence of syrup. Cloths dipped in this and laid on the part, 
proved sufficient for the removal of these granulations. Un- 
der any treatment, these cases will be tedious. The remedies 
which have been mentioned, may be varied and substituted by 
others of similar character. 

When burns are extensive, they will make a powerful im- 
pression on the constitution in the first instance. And very 
great prostration is the consequence of an excessive burn. I 
have no hesitation in administering to such patients laudanum 
in large doses, and following it up with brandy, till a high de- 



SURGERY. 663 

gree of fever comes on. When this fever supervenes, it is to 
be treated according to its character. Mild cathartics are 
commonly all the remedies I have found it necessary to use. 
Where the injury has been very great, and the patient continues 
in a prostrate condition resembling typhus fever, the stimula- 
ting plan of treatment should be persevered in to the end. In 
these painful cases, great relief may be, from time to time, ob- 
tained by the use of laudanum or opium in some form. I am 
not conscious that it hinders the cure, and great is the comfort 
which is, many times, derived from it. It may be used accor- 
ding to the symptoms ot^ the case. 



SURGERY. 

It will be expected that certain cases of surgery will be 
treated of in this work, and I should satisfy this expectation 
with more pleasure, if I could select the subjects of my re- 
marks amongst those of less importance and of easy compre- 
hension. But accidents give rise to many of the most difficult 
and important cases of surgery; and they happen without giv- 
ing warning of their approach, or allowing much time for the ob- 
tainment of surgical aid. I shall confine myself to such as are 
most frequently met with, leaving others to those who write 
treatises particularly devoted to this part of science. 

FRACTURES. 

A bone broken by any kind of violence, constitutes a frac- 
ture. These accidents are liable to occur in any of the bones 
of the body ; but they are much the most frequent in the arms, 
or the legs. They are all to be treated with the means best 
calculated to bring them into the exact position in which they 
grew, and retain them there. If this can.be accomplished, 
the bone unites in a reasonable time ; and its strength is not in 
the least impaired. When the soft parts are at the same time 
penetrated, so as to make an opening from the surface to the 
broken ends of the bone, it is a compound fracture ; and ex- 
perience has shewn, that the inflammation and suppuration 
which follow, are serious and alarming. When the bone is 
broken into many small pieces, and an external opening from 
the surface also made, the case is often so serious, as to call 
for the amputation of the limb. Where cases of this kind take 



664 SURGERY. 

place, no time should be lost in procuring the best advice ; but 
if fractures, are unattended with these injuries, there is less 
danger in them. Great injury is often suffered by allowing 
bones to unite in unnatural positions, producing permanent de- 
formity of the limbs. It is therefore always prudent, to pro- 
cure the aid of a skilful surgeon, in the treatment of fractures. 

FRACTURE OF THE SKULL, 

The large size of the human brain, and the exposed situation 
of the head, render the fracture of the skull, by no means a 
rare occurrence. When the skull is merely cracked, although 
the skin may be torn off, leaving the bone exposed, it is only 
necessary to treat the wound of the scalp, and to close it over 
the skull in the best way, to cause its speedy union. But 
where the bone is depressed, and placed in a situation to pro- 
duce permanent pressure on the brain, the accident is more 
serious. Able surgeons teach us, to let such depressions re- 
main, unless they produce symptoms of dangerous pressure 
on the brain. These symptoms are a total destruction of men- 
tal power, with spasms, stertorous breathing, &c. These 
S}^mptoms call for the elevation of the depressed bone, which 
is only to be attempted by an experienced surgeon. Of the 
necessit}' of this operation, it is not always easy to determine. 
Where there is manifest and considerable depression, I should 
sooner hazard the operation than to let the depression remain. 
The consequences of its remaining, may prove serious, at a 
remote period. 

FRACTURE OF THE ARM. 

The arm may be fractured above or below the elbow. 
Above it, the fracture itself is more obscure, but the treat- 
ment much more safe and easy. By taking hold of the arm 
at the elbow, and raising it even with the body, if it is fractur- 
ed, it will bend, producing great pain. By taking hold of the 
part affected, and moving the limb at the elbow, the ends of 
the bone will be distinctly felt to move on one another, with 
roughness or crepitation. When this accident does not hap- 
pen too near the shoulder or the elbow, the treatment is very 
simple. A roller, or narrow bandage, is to be passed around 
the arm, so as to reach from the elbow to the shoulder. Care 
should be taken, that this bandage is not too tight, and the hand 
and forearm should be frequently noticed, to see that the cir- 
culation in them is not obstructed. Over the roller a thick 



SURGERY. 665 

piece of paste board, surrounding the arm, is to be applied. 
The lid of an old book, made soft in water, will answer the 
purpose very well. This should be bound around with an- 
other roller, so as to fit the arm easily. A thin layer of cotton 
may be used to make the application more easy. Care should 
be taken to keep the part still, until the paste board becomes 
dry. It will then be hard enough to remain straight; and by 
keeping the arm in a sling, and bent across the body, the cure 
will progress favorably. Many things might answer as well 
as this paste board ; but, in my hands, it has always answer- 
ed very well. At the end of four or five days, the arm should 
be stripped, and the dressings put on anew, after which, they 
should remain till the bone is united. 

Fractures of the forearm are much more liable to produce 
deformity, than those of which I have been treating. This 
deformity commonly grows out of the shortness of the splints, 
which leave the hand unconfined, and allow it to roll in a dif- 
ferent direction from that taken by the bones of the arm. This 
is remedied by extending the splint from the elbow to the palm 
of the hand, so that the fingers can bend over the end of it. 
This splint may be of a piece of wood, made sufficiently thin, 
and two other pieces to be confined on the sides of the arm. 
But when it can be obtained, a piece of paste board, long 
enough and sufficiently strong, may be used with more con- 
venience and advantage. This should be made thoroughly 
wet, and applied with cotton interposed about the wrist, so as 
to make it fit with perfect ease, but still support the hand and 
hinder its turning. Great care should be taken, that this paste 
board is allowed to get thoroughly dry without being bent ; 
for it is on this we are to rely, for the preservation of the 
straightness of the arm. The application of bandages or rol- 
lers, is the same here as in the treatment above described of 
fractures of the arm above the elbow. The arm should be 
flexed or bent across the body, and supported in a sling around 
the neck. Perfect cures of this fracture, are often hindered by 
the rolling motion of the two bones of the forearm. It is diffi- 
cult to keep them still, and exactly in place. 

FRACTURE OF THE THIGH. 

This is the largest of the hollow bones, and is frequently 
fractured. Surrounded as it is by very thick flesh, the exami- 
nation of its injuries are difficult. When the fracture is near 
the middle of the bone, its existence is obvious ; when the 



666 SURGERY. 

limb is lifted or turned, the crepitation or rubbing of the ends 
of the bone, is easily felt. If the patient lies on his back, the 
foot will fall down on its side, the toe point out to one side 
when it should be forward. The limb is commonly shortened 
an inch or two, which may be seen by placing the two knees 
together, while the patient lies on his back. Some skill is ne- 
cessary to manage this test, for the hips are not always kept 
even at the time. This shortening of the limb, attends also a 
luxation of the hip ; and care should be taken to feel or hear 
the rabbins' of the ends of the broken bone. Where the frac- 
ture is near the head of the bone, the nature of the injury is 
sometimes very difficult to detect. 

A fractured thigh bone will almost always be shortened, 
and if it gets well, remain so, unless it is hindered by skill in 
the application of dressing and splints. Many are the plans 
which have been proposed, but my faith is strong in that pro- 
posed by Desault, some seventy years ago. This plan pro- 
poses the permanent extension of the limb by means of a splint 
extending from the arm-pit down the leg, and five or six inches 
below the bottom of the foot. Through this splint, holes are 
to be made above the hip, and at the lower end below the foot. 
A bandage is now to be passed between the thighs, and around 
the broken limb to the holes in the splint .above the hip. A 
large silk handkerchief answers this purpose, or a piece of cot- 
ton cloth not too coarse, may be used in its place. The cor- 
ners of the handkerchief being carried through the holes, are to 
be firmly tied. A similar bandage is now to be placed on the 
foot, passing it so around the ancle, as not to draw tight around 
it, by being pulled. Pass this bandage through the holes at 
the end ol the splint, draw it pretty firmly and then tie it. 
The broken bone will now be seen to be between these two 
bandages, operating in different directions, and producing ex- 
tension. Great care is to be taken that the foot is kept in its 
natural position. If the toe is allowed to turn too far out, or 
too far in, and thus remain till the bones unite, the deformity 
will be palpable, and a great and permanent injury be done to 
the patient. The extension of the limb to its natural length is 
not to be attempted at this time ; but the bandages are to be 
lightended from day to day, till it is accomplished. This 
should be done with great care ; and no force should be ap- 
plied, which cannot be conveniently borne. When too much 
force is used, the skin gives way on the foot or below the groin, 
and it becomes indispensible to lessen it. In other cases, the 
pain becomes intolerable, and I have seen violent convulsions 



SURGERY. G67 

the consequence. The cure in these cases, is seldom as per- 
fect as if attempted by gentle means. A moderate extension, 
if it is not allowed to relax, will seldom fail to bring the limb 
to its proper length, and of itself effect the setting of the bone. 
The patient is to be placed on a mattrass, with an even sur- 
face, and there remain on his back, till the cure is effected. 
This may require six weeks, and more in old persons. It 
looks like a dreadful penance to be placed in this situation for 
so great a length of time. But the patient is to be told, that 
after the first week, his sufferings will be more tolerable ; and 
that he is to bear them to the end, or rise with a permanent de- 
formity of the limb. 

FRACTURE OF THE LEG. 

There are two bones in the leg, and when one is fractured, 
and the other not, there is little difficulty in making the adjust- 
ment of the broken bone. The part is so thinly covered with 
flesh, that the nature of the injury is easily discovered. When 
one of the bones is unbroken, it secures the straightness and 
length of the limb. Still the patient should remain in a fixed 
position ; or if he moves, do it with crutches, so as not to bear 
any weight on the limb. A wide and strong piece of paste 
board, bound well around the leg, and allowed to dry in that 
situation, is the best splint. 

When both bones are broken, there is great danger of defor- 
mity of the limb, from the toe being allowed to turn too much 
out or in. A wooden box with three sides, is thought the best 
security against this. The patient is to be placed on his back, 
and the box should be near enough to the size of the limb, to 
prevent its bending. The interstices which will be left, may 
be filled with cotton carefully stowed in, so as to give equal 
pressure to every part. Bran thrown in and made to pass 
down around the limb, is said to answer this purpose still 
better. 

Where fractures are attended with great injury of the flesh, 
and the bone is broken into many pieces, dressings are obliged 
to conform to these circumstances. More or less deformity- 
will occur, where extensive suppuration and the loss of bone 
take place. The preservation of life and limb is here the 
great consideration. 

LUXATIONS. 

A bone which is thrown out of its socket, is said to be luxa- 
ted. This accident is of frequent occurrence, and requires but 



66S SURGERY. 

the replacement of the bone, and its retention in its place to 
effect a cure. They are not all replaced with equal ease, and 
some of them are necessarily attended with so much injury to 
the joint, that when they are replaced, the cure is yet far from 
being accomplished. When they are- complicated with bro- 
ken bones, and wounds of the surrounding parts, they are 
sometimes wholly unmanageable. 

LUXATION OF THE SHOULDER. 

This is the most frequent of all luxations. The head of the 
arm bone leaves its socket, and is sometimes thrown down into 
the arm-pit, and sometimes backwards or in front of that po- 
sition. 

The replacement of the shoulder, when it is luxated, is some- 
times eas}', and at others, very difficult. When the head of 
the bone is in the arm-pit, it is easily discovered by feeling ; and 
at the same time the collar bone and part of the shoulder blade, 
will project and show the cavity which was previously occu- 
pied by the head of the arm bone. This is always a symptom 
of this luxation. 

So many easy methods of reducing this luxation, have been 
published, that I have some difficulty in choosing amongst 
them. The last is the easiest, and deserves a trial. Take a 
strong chair, and place on the back of it a cushion, about equal 
to the arm in size. Set the patient in this chair, and let his 
arm hangover the back of it, resting the arm-pit on the cush- 
ion. Bind a bandage around the limb, above the elbow, and 
tie the two ends together like a stirrup. The surgeon is to 
place his foot in this stirrup and rise, as if to mount a horse. 
His weight thrown on the arm reduces the luxation. I have 
long used a different method. Place the patient on a stool, 
near a tree or post. Pass a wide bandage around his body, 
and around the post, so that he cannot be drawn from it. A 
surcingle answers this purpose very well. Pass a handker- 
chief under this bandage and over the shoulder, so that it can- 
not slip down the bod}'. Take a long towel, or two yards of 
common homespun, and bind the middle of it to the arm above 
the elbow, with many turns of a bandage. The two ends may 
be taken for the application of force to reduce the luxation. 
The surgeon is then to take hold of the arm, and two assistants 
pull the arm, allowing the patient to lean, so that it may be 
drawn as if it were elevated considerably higher than the shoul- 
der. The surgeon will move the hand, so as to give to the 



SURGERY. 669 

bone a rolling motion during the pulling, and if he is watchful, 
he will feel the bone when it enters the socket. The pulling 
is instantly to be suspended. The luxation downwards has 
never failed in my hands to be instantly replaced by this meth- 
od. Lately, I had a case in which the head of the bone was 
thrown forwards. This case resisted my old plan, and after 
hard pulling by my assistants, and great suffering by the pa- 
tient, he was arranged for a downward pull, thus the luxation 
reduced. I have no doubt that the plan I have described of 
pulling the arm over the back of a chair, would have relieved 
him promptly. When the shoulder is restored to its place, the 
arm should be carried in a sling, and the elbow kept near the 
side, till the soreness and inflammation are removed. This in 
some instances, requires considerable time. 

LUXATION OF THE ELBOW. 

This is a rare occurrence, but very difficult to remedy. The 
luxation can happen only backwards, which leaves the elbow 
incapable of being bent, and the arm shortened considerably. 
The extension and replacement of the bone are very difficult. 
They are to be attempted by pulling at the hand, and straining 
the elbow with some force, as if to force the hand backwards. 
The process of the bone which hinders the reduction, may in 
this way pass over the head of the arm bone into its place. 
This operation will hardly succeed in common hands, if it does 
in any other. 

LUXATION OF THE HIP. 

Great force is required to replace the head of the thigh bone, 
when it is thrown out of place at the hip. It is not often ac- 
complished, but the failures are commonly the effect of making 
the attempt with too feeble a force. Three men with all their 
force, will hardly pull the limb of one of strength equal to 
themselves, with more force than it requires. 

The luxation of the hip is known to have taken place, by 
the great pain, shortened limb, toe turned inward, and thigh 
firm and resisting. In some rare instances, the limb is length- 
ened, and the toe turned outwards. In both cases, the state of 
the thigh is about the same. 

The reduction of this luxation is to be attempted by placing 
the patient on a table, with a strong bandage passing between 
his thighs and along his body, to be attached to some immova- 
ble thing beyond his head. Another bandage is to be attached 



670 ULCERS. 

firmly to the thigh above the knee. By this a force sufficient 
to extend the limb is to be made. The surgeon is to take hold 
of the leg at the foot and at the knee, giving it a rotatory mo- 
tion at the time the extension is made. There is more force 
than skill required in this operation. When the young surgeon 
has used all the force he dares to put on his extending ban- 
dages, and is about to say stop to his assistants, he will proba- 
bly hear and feel a sudden snap at the joint, and the bone will 
be replaced. This has been my experience. 

LUXATION OF THE ANKLE. 

This is in some persons a small joint to sustain the weight 
of the whole body. It is frequently injured, and sometimes 
thrown out of place. The accident is easily judged of, be- 
cause of the thin covering of flesh over the bones of the foot and 
ankle. Commonly there is no difficulty in replacing the bones; 
but the ligaments of the joint are much torn, and time and rest 
will be requisite to restore the soundness of the joint. Some 
of these accidents carry with the leg bones, one of the bones of 
the foot, producing great difficulty in the reduction of the luxa- 
tion. 

The violence which attends luxations is often very great, 
and the wounds which at the same time take place, are a sub- 
ject of treatment for themselves. All these things call for a 
sound discretion on the part of the practitioner, and are to be 
provided for according to circumstances. 



ULCERS. 

Any part of the body which has ics continuity broken, by 
the effect of disease, is said to be ulcerated. An ulcer differs 
from a wound, inasmuch as the broken substance which owes 
its existence to a wound may be healthy, and have a strong 
tendency to heal, while an ulcer has arisen from causes which 
must be removed before healing can take place. 

The most common cause of ulcers, is scrofula, but syphilis, 
cancer, varicose veins, and many other diseases produce ul- 
cers, some of which are incurable. In other instances, ulcers 
appear to depend on the disease of the part they occupy, with- 
out affecting the general health. 

When ulcers depend on a vitiated health, or the presence of 



ULCERS. 671 

any known disease ; that disease is to be removed before we 
can expect the permanent cure of such ulcers. But there are 
many cases in which the remote cause of ulcers is very ob- 
scure ; and we are compelled to treat them on principles 
which, in some degree, apply to all. I shall therefore devote 
some attention to the general rules of treating ulcers, as local 
disorders, leaving their remote causes to be treated of else- 
where. 

Some ulcers, like many diseases, have of themselves, a ten- 
dency to heal, after having produced certain effects — a boil or 
abscess may be of this description. Others, from the absorp- 
tion of the solid parts, expose the nerves of sensation, become 
irritable, and spread without any tendency to heal. Others, 
after having acquired some size, begin to fill up with granula- 
tions, but stop without healing, and become indolent, as it is 
termed. Others depend on a peculiar disease, and are thus 
kept up for an indefinite time. 

TREATMENT. 

Ulcers are to be treated according to their particular char- 
acter. If they are healthy, they require only protection from 
injury, with stillness and time. If they have much raw sur- 
face, and are of some depth, cover them with fine lint, and 
over this spread a plaster of simple ointment. It should be 
neatly applied, and secured in its place by a bandage suffi- 
ciently tight. If the discharge is so considerable as to run 
through the dressings in twenty-four hours, they should be 
renewed daily — if the discharge is less, their renewal should 
be postponed to the second or third day. 

Ulcers which are irritable, and tender to the touch, especial- 
ly when they are deep and ragged, yielding a thin and watery 
discharge, require a great deal more skill in their treatment. 
The object is to cause them to form healthy granulations, or 
flesh, from the bottom. This is to be promoted by applying 
stimulants daily ; such as lint dipped in spirit, or equal parts 
of honey and brandy, or tincture of myrrh. Over lint lightly 
laid on, and wet with either of these articles, a plaster of sim- 
ple ointment should be laid. If the case is bad, the patient 
should be kept still ; if the ulcer is on the leg, he should be 
confined to his bed. If it can be borne, a tolerably tight ban- 
dage should be applied; and if any one of these remedies fail 
to improve the appearance of the ulcer in a few days, try an- 
other. If the case does not improve, try escharotics. First 



672 ULCERS. 

try lunar caustic, applied fully and freely to the whole ulcera- 
ted surface. If this fails, try red precipitate in powder. Let 
this in a dry state be equally sprinkled over the whole surface 
of the sore. In all these, resources, our reliance is sometimes 
misplaced, and the ulcer will grow worse. Try next the ap- 
plication of dr} r lint, without any plaster over it. Scrape the 
lint extremely fine, and put it into water.; take out a small por- 
tion of it at a time, but cover all the ulcer thickly and equally 
with it. Let it remain exposed to the air till it dries, and keep 
the patient as still as possible, avoiding exposure to cold. And 
now if I am asked, if I have any system of treating these ul- 
cers, I answer that my profession supplies me with no better 
than I have given. In all cases, avoid dressings too frequently 
repeated, and do not continue a remedy too long, if it produces 
no amendment in the case. 

Indolent ulcers are found most frequently on the legs. They 
are often caused by a state of general ill health, and may con- 
tinue for many years. It is thought to be not safe in every 
case to heal such ulcers ; but I have not found the danger very 
great. These ulcers are to be treated as the effect of debility, 
never forgetting the remedies suited to the general health of 
the patient. To the ulcer, apply lunar caustic, or red pre- 
cipitate in powder. Then lay over it a dressing of lint, and 
over this strips of adhesive plaster, firmly drawn on. A roller 
four yards long is then to be well applied from the toes to the 
knee. This dressing should be applied once in two days. 
The caustic, or precipitate will hardly require more than a 
second or third application. The foul, dark appearance of the 
ulcer, will change to a more healthy color, and lint dipped in 
tincture of myrrh or spirit of any kind, will be sufficiently 
stimulating. By degrees, all these stimulants may be laid 
aside ; but the adhesive strips and bandage are to be continu- 
ed to the end. This is Baynton's method of treating indolent 
ulcers; and it is, in my opinion, one of the great improvements 
of modern science. I remember when it was a common thing 
to amputate sore legs. And I well remember the fame of a 
man who cured such ulcers, by tying his patient down on a 
ladder, and surrounding the sore with a rim of clay, into which 
he poured hot tallow, assuring his patient after his agony was 
over, that, " any one could cure a burn." 

The ulcers which arise from particular diseases, such as 
scrofula, may put on some of the appearances above described. 
They are to be treated according to their symptoms, always 



WARTS AND CORNS. 673 

recollecting to continue the remedies for the remote cause, 
whatever it may be. 

When ulcers take on a healthy action, the granulations of 
new flesh sometimes shoot up too high, and the process of heal- 
ing is suspended. Astringents are the remedies to reduce 
these granulations. Oak galls, or powdered alum, judiciously 
applied, answer every purpose. In treating of burns, I had 
occasion to mention the means of hindering and of removing 
these granulations. I need not repeat them. 

I ought not to close this essay, without mentioning the use 
which is now made of cold water, in the treatment of ulcers. 
It is applied, I apprehend, without much regard to the particu- 
lar character of the ulcer. Fine cloths dipped in cold water, 
are spread on the sores, and lenewed often enough to hinder 
them from becoming dry, by day or night. This practice is 
more suited to hospitals than to private families, and alter all, 
I doubt its benefits to many ulcers. I do not recommend it to 
those whose knowledge of medicine is limited. 



WARTS AND CORNS. 

Warts are small tumors on the skin, which produce neither 
pain nor inconvenience, and after a considerable time disap- 
pear of themselves. When from their number or appearance 
it is desired to have them removed, it is easily done with any 
keen instrument. By raising them a little with a pair of for- 
ceps or fine thread passed through them, they can be cut off 
with a pair of scissors, without causing much pain. Lunar 
caustic should be applied to the wound. Where the pain of 
this operation is objected to, strong astringent applications are 
to be made to the warts, and repeated daily for a considerable 
time. A solution of sulphate of copper, may be tried. A plas- 
ter of extract of oak bark, will, I have no doubt, remove them 
speedily ; or caustic potash will destroy them at a single ap- 
plication. But I have not tried these last remedies. 

Corns are of two kinds, the hard and the soft. They both 
arise from pressure on any particular spot, of the skin, and are 
met with on the feet or toes. They consist of the external lay- 
er of the skin thickened and indurated. Between the toes of 
some persons, theie is moisture enough to keep these excres- 
cences soft, but they are none the less painful on that account. 
The soft corn should be removed, by taking hold of it with a 
43 



674 ' WARTS AND CORNS. 

pair of forceps, drawing it out a little, and cutting it off with a 
pair of scissors. It will heal readily, and not return again. 
Hard corns are taken out with a knife, removed by applying 
caustic potash, or hindered by wearing soft shoes. But I pre- • 
fer removing them by softening them- with a poultice, repeated 
so as to keep it all the time moist, for a day or more. The 
corn will be made soft; it should then be removed,' and not 
allowed to get dry, which would make it harder than ever. 
The skin will be left tender and thin, and the corn return after 
a time from the same cause. These directions apply to the 
worst cases of corns ; but in most instances, by placing the 
foot for half an hour in very warm soap suds, the corn will be 
so softened that it may be removed with .the finger nails, or 
scraped off with a case knife. 

TOE NAILS GROWING INTO THE FLESH. 

The frequent paring of the toe nails and rounding off the 
corners, is the sole cause of this troublesome affection. By 
this operation, which is commonly made the more pernicious 
by taking out the hard skin, with which nature supports the 
corner of the nail, the flesh rises up, and is soon so situated as 
to be 'pricked at every step, A flow of matter now takes 
place, which so softens the nail as to allow it to bend, al- 
most always 'from a bad to a worse direction. 

Surgeons cut through the nail near its centre, and tear out 
one half of it with a pair of forceps to remove this mala- 
dy. The remedy is worse than the disease, and is unne- 
cessary. Place a little lint before the toe nail. Remove 
it and insert a new piece every day if there is a flow of 
matter from the part ; if it is dry, let it stay for three or 
four days. By degrees, you will acquire skill, and learn 
to insert the lint before and under the corner of the nail, 
which will relieve the pricking pain felt at every step. 
When the nail is by this means conducted forward past the 
flesh, the cure is accomplished. The patient should do it for 
himself. In an old case where the flesh has mounted high 
over the corner of the nail, it may require considerable time to 
effect a cure ; for the patient will shorten the nail to rid him- 
self of pain. Still he should continue the lint, and let the nail 
grow still longer from time to time, and the cure will be ac- 
complished in the end. After the cure is effected,' the patient 
is scrupulously to deny himself the pleasure of rounding off 
the corners of his great toe nails, and tearing out the hard skin 
which nature has so wisely put in its place. 



TOOTH ACHE. 675 

TOOTH ACHE. 

Few persons live to middle age without experiencing more 
or less tooth ache. The pain is sometimes intense, but in its 
best form sufficiently annoying. I offer a few words of advice 
to sufferers. Where the tooth is tender and so decayed as to 
admit of putting any thing into it ; take a piece of oak gall, 
trim it with a knife small enough to go very loosely into the 
tooth. It will soon become soft, and fill the cavity perfectly 
without pain. After a day or two, it may be removed and 
another inserted ; in a few days the sensibility of the nerve of 
the tooth will be destroyed, and its bad smell removed. The 
same remedy may be applied in the form of tincture of galls, 
into which a small piece of cotton may be dipped and put into 
the tooth with a pin. This, repeated daily, will in a short 
time, destroy the nerve of the tooth, and the pain will cease. 
Other and more caustic articles may be used, but I prefer the 
simple astringent I have mentioned. When an acute inflam- 
mation attacks the substance surrounding the root of the tooth, 
it should be extracted immediately ; but if this is delayed a 
single day, it is too late, and suppuration will take place. 
This happens at the root of the tooth, almost compelling its ex- 
traction ; but more frequently the suppuration will be exter- 
nal, and admit of the discharge of the matter by an opening 
with a lancet. Remedies afford but little relief in this form of 
tooth ache. There is yet another form of this disease, which 
I have thought depended on rheumatism. The pain spreads 
along the jaw, so that the patient can hardly decide in his own 
mind which tooth is in fault. After days of suffering, he will 
probably insist on the extraction of some tooth which he thinks 
may be the cause of all the pain ; but the operation is useless, 
and the pain will continue. No soreness of a particular tooth 
will enable us to determine the seat of the disease. Such cases 
are to be treated as rheumatism, and he may consider himself 
fortunate, who finds the disease to give way in a short time. 



WOUNDS. 

Wounds have been divided into several kinds, but it is my 
purpose to treat of such only as arise from incisions, or cuts, 
punctures, or those made by pointed instruments, and contu- 
sions or bruises. With punctures and contusions, we may 
well include gun-shot wounds, and lacerations of the flesh 



676 wounds. 

which may vary a thousand ways. In all cases of wounds, 
the surgeon should first assure himself, that the flow of blood is 
stopped. If large arteries are divided, they are to be secured 
by ligatures, and if smaller ones continue to bleed, pressure is 
to be made on them in a way to arrest the discharge. Styp- 
tics, such as alum, lunar caustic, and blue vitriol, are admissi- 
ble only in cases in which the flow of blood is from vessels not 
easily reached. In these cases, the application of either of 
these remedies, will exert a powerful control over the bleed- 
ing. When the hemorrhage is stopped, wounds are to be 
treated according to their character. 

Cuts made with a clean sharp instrument, should be brought 
together exactly as the parts grew, and secured in their posi- 
tion firmly. The best means of doing this, is by securing the 
edges of the wound with adhesive plaster, and then passing a 
supporting bandage around the part. This bandage should be 
applied neatly and firmly, and the patient placed in a situation 
in which he will be least liable to move or separate the divided 
parts. This dressing should remain unopened for four days, 
when the wound will have healed. This simple treatment is 
all that is required for a common cut, and whatever is added, 
makes the matter w T orse. 

But cuts are sometimes on parts which it is not easy to bring 
into their proper positions ; in other instances, they are attend- 
ed with considerable bruising and violence to the parts. These 
may, as far as practicable, be dressed in the same way, and 
remain till the fourth day, before the second dressing is put on. 
If the parts have not been perfectly adjusted, or there is much 
laceration or bruising in the wound, the healing will be found 
to have been but partial, and more or less inflammation and 
suppuration will take place. The second day will commonly 
produce pain and inflammation, which should be treated with 
cold applications. Cloths dipped in cold w r ater, or poultices of 
slippery elm, may be used according to circumstances. The 
object is to keep the part moist and cool, and thus to hinder the 
spreading of the inflammation. Where there is suppuration 
and a loss of substance, the healing will be slower ; but, for a 
week or more, the adhesive plasters and cold applications over 
them, should be continued. When the wound has thrown out 
granulations and assumed the appearance of a common sore, it 
is to be treated on the plan pointed out for ulcers. 

Punctured wounds are more painful and dangerous than 
cuts. The most common wound of this description, is that 
made by treading on a nail, and having it enter the foot. Lock- 



wounds. 677 

ed-jaw has frequently happened from this accident. But a 
wound from a bayonet, or small sword, is equally productive 
q{ irritation and pain, and similar wounds may happen in a 
thousand other ways. Wounds of this description often swell 
rapidly, and give violent pain ; and, if sufficient inflammation 
follows them, end in suppuration. 

The treatment of punctured wounds must vary with circum- 
stances. Immediately after the accident, apply an adhesive 
plaster over the puncture, lay over this a compress of lint, and 
apply a tight bandage over the part. If the pain is considera- 
ble, give forty drops of laudanum. If the pain increases, and 
the swelling of the part is such as to endanger the circulation 
in the limb, take off the bandage, and apply cloths dipped in 
cold water. Where the parts punctured are tendinous, or near 
leading nerves, the cold applications sometimes increase the 
pain, and are beneficially exchanged for hot ones. Diligent 
attention is necessary in these cases, and the hot applications 
should be withdrawn as soon as the pain is lessened. Where 
the puncture is deep, hot applications should be avoided, as 
their tendency is to produce suppuration. 

It has been recommended, to lay open a punctured wound 
to its bottom, by a free incision with a knife, and thus to make 
of it a wound entirely different. This is at best a doubtful 
policy. Punctured wounds sometimes get well as readily as 
cuts ; others in which the incision is made, still run into a 
violent inflammation and suppuration. Besides this, these 
wounds often penetrate parts in which a deep incision would 
be dangerous, and ought not to be attempted by the unskilful. 

Wounds from gun shot, partake of the character of contu-* 
sions, as well as punctures. The violence of the injury de- 
stroys the flesh, and leaves an opening where the shot has 
passed. These wounds are less dangerous than punctures, 
because although they produce inflammation and suppuration," 
the matter readily escapes, and the cure, however retarded, is 
not prevented. 

The dressing of gun shot wounds, should be very simple ; a 
piece of lint laid over the wound and covered with a plaster of 
simple ointment, is most approved. The inflammation which 
follows should, for a few days, be treated with cold applica- 
tions ; but where the ball is large*, and the injury of the part 
very great, warm poultices to promote suppuration, will be 
best. They should be discontinued when the wound ceases 
to be painful. 

Little need be added with regard to wounds in which the 



678 DISEASES OF THE SKIN. 

flesh is still more lacerated, and the parts more injured. As a 
general rule, the parts should be brought together and bound 
up firmly, care being taken that the bandages do not grow so 
tight by the swelling of the limb, as to stop the circulation in it. 
If parts are so injured, that it is impossible to save them, they 
should be amputated. But this is only to be attempted by a 
skilful surgeon, and I may say to such a one, be not too hasty 
in performing these operations, for many limbs recover from 
wounds which seem to offer very little hope. 



DISEASES OF THE SKIN. 

The skin is not only an investment for the body, but per- 
forms functions essential to health and perhaps to life. We 
have described several important diseases, which display on 
this organ their characteristic symptoms ; and it is now our 
purpose to give some account of those which attack the skin ? 
either as original diseases, or result from some chronic general 
disorder. The difficulty of doing this, is increased by the 
want of terms in common language to express the variety of 
these disorders — most of them are without a common name. 
We shall notice only such as are most common, and these we 
shall not attempt to arrange in classes. 



1 PEMPHEGUS. 

This is a frequent disorder, but so mild and transient, that 
it has not obtained a common name. It consists in an erup- 
tion of blisters with red bases, scattered irregularly over the 
body. These blisters soon form crusts or scabs, and in a 
short time fall off, leaving the spot a little red. In some cases, 
successive crops of these blisters appear, and hinder the re- 
covery of the patient, for a considerable time, but in the end 
they all dry away. 

TREATMENT. 

The disease is often so mild, as to call for no treatment 
whatever; but where there is some fever, a cathartic of cream 
of tartar and sulphur, or a Seidlitz powder may be given. If 
there is much itching of the skin, apply a wash of twenty 



SHINGLES. 679 

grains of corrosive sublimate, and a drachm of sugar of lead 
dissolved in two ounces of water. Wet the eruption without 
rubbing, and let the part dry. Apply no oily application. 



SHINGLES— ZONA IGNEA. 

This disease is an eruption on the skin, with considerable 
fever, and a burning and smarting pain in the part affected. 
Chilliness, headache, and pain in the back and limbs, precede 
the eruption. In a few hours, a stinging pain will be felt in 
the skin — commonly on the side, but other parts of the body 
are often affected. In a day, a cluster of little blisters will 
arise, which soon spread and several run together. A con- 
siderable inflammation attends, and the pain is often very in- 
tense. In three or four days, new crops of vesicles appear on 
the edges of the old ones, and the disease thus spreads, as if 
to surround the body, or the limb on w T hich it appears. In 
this way the disease progresses, forming a kind of girdle about 
the body, not wider than the hand. But this girdle never goes 
entirely around, and in most instances, not half way around 
It usually progresses for ten or twelve days, when it stops, 
and the eruption dries up and the scabs fall off. The dis- 
charge from this eruption is very small. 

TREATMENT. 

Where there is much fever and sickness at the stomach, 
give ten grains of calomel, and follow it with a Seidlitz pow- 
der or other mild cathartic. If the patient is restless after the 
cathartic has operated, give thirty drops of laudanum, but do 
not repeat it again. The local remedies are not very well 
agreed on. In mild cases, nothing need be applied to the 
part ; but where the burning and smarting pain are considera- 
ble, cooling remedies afford great relief. A solution of sugar 
of lead may be applied by means of cloths dipped into it. But 
I prefer the following application. Take two ounces of alco- 
hol, and half an ounce of lapis calaminaris. Mix them to- 
gether in a vial, and apply this to the part with a feather, 
keeping the mixture well shaken, and continuing the applica- 
tion for fifteen minutes at a time. The evaporation of the al- 
cohol will cool the part, and the powder will be left to protect 
the tender skin, and to close such cracks as may happen in it. 



680 TETTER. 

I have often used this remedy with great benefit. It may be 
applied twice a day, till the disease ceases to spread. 



TETTER— HERPES. 

A variety of diseases of the skin are known by the name of. 
tetter. There are two varieties which I think it necessary to 
mention, the humid and the dry. 

Humid tetter is attended with some inflammation and thick- 
ening of the skin, with blisters, which form in clusters, and 
soon run together and burst, causing a flow of watery fluid 
from the part. It may attack any part of the body, but is most 
frequently seen on the head and face. It is sometimes acute, 
running its course in a short time, with considerable inflamma- 
tion, but more frequently it is chronic and continues without 
abatement for a considerable length of time. 

The crusted tetter, or scall, attacks the skin in the same way, 
with clustered points of inflammation ; but these produce sup- 
puration, and a discharge of more or less yellow matter. This 
matter is in very small quantity, and as it reaches the surface, 
dries into a scab or spurf on the skin. This scab is soft and 
porous, easily broken, and does not form a protection to the 
parts under it. This species of tetter cccurs most, frequently 
on the head, producing the common disorder, scalled head ; 
but it attacks other parts of the body. These two kinds of 
tetter are very common ; they are considered local diseases, 
but they are hard to cure. No alterative or general remedy of 
any kind seems to be of any service to them. 

REMEDIES. 

The difficulty of curing these kinds of tetter, appears to me 
to depend on the seat of the disease, which is deep in the skin. 
The remedies applied destroy it on the surface, but leave it 
uncured below, and it soon makes its appearance again. It is 
manifest that escharotics, such as creasote, lunar caustic, or 
muriatic acid, destroy it where their application is perfect. 
But the scab, or the epidermis, intervenes and hinders the ac- 
tion of the remedy on the part affected. Plasters of pitch, or 
caps of tar, have cured many cases, but it seldom fails that 
some uncured spots remain, from which the disease will spread 
again. A writer of Europe says, that these diseases are more 



DRY TETTER. 681 

common at the South than they are at the North. I say with 
equal evidence, that they are abundantly more prevalent at 
the North, especially in Europe ; and that the myriads of ver- 
min they describe there, have nothing to compare with them 
on the heads of the poorest negroes at the South. 

The remedies most relied on, are intended in the first in- 
stance, to expose the ulcerated surface. This may be done by 
the application of cold water with towels kept constantly wet, 
and applied till all the scab or skin is removed. Then apply a 
solution of lunar caustic in water, thirty grains to the ounce, 
once in two or three days, and still keep up the cold applica- 
tion. Muriatic acid may be used in place of this, or creasote 
may be a substitute for both. Now these remedies are ex- 
ceedingly painful, and will frequently be avoided or rejected. 
They are sometimes sufficient, without making any effort to 
make the part raw for their application. Applied to the dis- 
ease in this way, they are less painful, but much less effectu- 
al. It will be observed, that I mention the same remedies for 
both these varieties of tetter. This is done advisedly. The 
dry and crusted tetter are both diseases of the true skin, the 
same remedies must be used to reach them. 



DRY TETTER. 

This variety of tetter resembles the rest, only in attacking 
the true skin, and producing more or less inflammation. It 
produces no suppuration or discharge of any kind. It attacks 
the skin of the hands and feet, sometimes extending to the 
nails. It is usually worse in winter than in summer, and ap- 
pears to be worse in hands which are most exposed to wet and 
cold. In the skin it produces cracks with smarting and itch- 
ing, and sometimes an oozing of moisture which evaporates, 
leaving a covering of white scales like bran. 

This form of tetter is exceedingly obstinate, yielding in a 
temporary way to strong remedies, but returning again at its 
leisure. The best remedy I have tried is creasote, but lunar 
caustic, or a strong solution of corrosive sublimate may an- 
swer as well. Gloves should be worn on the hands, and shoes 
on the feet, of persons afflicted with this disorder. I think 
washing too frequently with soap is injurious. On the contra- 
ry, I advise the parts to be rubbed with simple ointment, to 
fill up the cracks in the skin at least once a dav. 



682 

RINGWORM AND BARBER'S TETTER. 

I think I have not met with an intelligible account of these 
affections. The barber's tetter affects the face where the beard 
grows, and is thought to be contagious. I think this very 
doubtful, but the disease is very obstinate, and well worthy of 
notice. It resembles tetter in attacking the skin, and produ- 
cing redness, itching, and pain. It does not extend to the 
roots of the beard, and never causes it to fall out, but the pro- 
cess of shaving keeps it constantly irritated and inflamed. 

Ringworm is the most common of the tetter family. It 
makes its appearance in a red itching spot, which on inspec- 
tion, will be found to be composed of a cluster of inflamed 
points. By degrees it will spread around, and the point on 
which it first appears, will recover, so that the disordered spot 
assumes the form of a ring. If suffered to go on, it may die at 
one side and continue to spread at the other, still preserving 
its arched form. It frequently spreads on the face near the 
eyes, and along the fingers, but never attacks the nails or the 
eyes. It is a mild disease, and easily arrested, but it is sub- 
ject to return again. 

I offer the same remedy for ringworm and barber's tetter. 
Take of sugar of lead, tartar emetic, and corrosive sublimate, 
each forty grains; laudanum forty drops., Mix all together in 
two ounces of water. Apply this mixture to the ringworm or 
tetter, two or three times a day, till it produces a decided in- 
crease of the soreness of the part. It is afterwards to be used 
according to the appearance of the eruption, taking care to 
reapply the remedy as long as the disease continues. The 
reader will perceive that this is a compound of more ingredi- 
ents, than I usually make. The truth is, that I lately receiv- 
ed it from a friend, and have made some satisfactory trials of 
it. The tartar emetic is the new part of the prescription in 
my hands ; but I am ready to believe it the most important 
part of the remedy. Most cases of ringworm give way to 
remedies in more common use. A strong solution of coppe- 
ras, blue stone, or corrosive sublimate, will commonly remove 
the disease by being applied to it early. But should it re- 
turn, or prove untractable, I strongly recommend the above 
mentioned mixture. 



RED GUM. 683 

RED GUM. 

A rash on the skin of teething children, is sometimes alarm- 
ing to mothers, though not dangerous to the children. This 
rash is characterised by redness, itching, and thickening of the 
skin. The itching comes on in paroxysms, and produces great 
restlessness and crying, by which the heat and itching are in- 
creased. A dose of paregoric or laudanum, with a warm 
bath, is sufficient treatment. 



INTOLERABLE ITCHING. 

Prurigo is the term which has been used to signify an intol- 
erable itching of the skin, on any part of the body. It is en- 
titled to be considered a disease, when from its long continu- 
ance or frequent returns, it becomes too annoying to be borne. 
It is not apt to occur on any of the extremities, but on the body, 
or about the anus or organs of generation. It sometimes fol- 
lows a slight eruption of herpes or some other disease ; but the 
itching affects the unbroken skin, and unless the surface is 
broken by scratching, there is no appearance on the skin to in- 
dicate the presence of the disease. The itching is alwa}^s an- 
noying, and becomes at times intolerable. It is often so bad 
that the patient will rub and scratch the part, till it becomes 
too sore to allow of its continuance. The itching will then 
subside, but return again at its time. This disorder, is thought 
to arise, from the diseases of important organs transferred to 
the skin ; and many persons have better health during the con- 
tinuance of this troublesome disorder, than at any other time. 

REMEDIES. 

In slight cases of this disease, I think it best to avoid the use 
of remedies ; but there are many instances in which the pa- 
tient cannot consent to endure the pain if it can be relieved. 
The local remedies which have been recommended, are ano- 
dynes and astringents. Put a drachm of sugar of lead into 
half a pint of water, and add a table spoonful of laudanum. 
Bathe the part with this mixture for ten or fifteen minutes, and 
then dry the part, and apply heat in any convenient form. A 
heated smoothing iron, held over thick folded flannel, is a con- 
venient and efficient mode of applying heat ; . and, in this dis- 



684 LEPROSY. 

ease, the heat is the most important remed}'. The itching will 
in this way be controlled for the time ; but its return is to be 
hindered by internal remedies. Arsenic is the best remedy 
for this purpose. Take of Fowler's solution, ten drops twice 
a day, and continue it for two weeks if necessar} r . If this 
gives no relief, take corrosive sublimate, about a quarter of a 
grain twice a day. The hvdriodate of potash, may be tried if 
no relief has been otherwise obtained. Dissolve a drachm of 
this remedy in an ounce of water, and take twenty drops of it 
two or three times a day. 



LEPROSY. 

The disease we call leprosy, differs widely from that de- 
scribed by Moses, as an infectious disease amongst the Jews. 
We have no contagious leprosy in the United States. The 
disease we call by this name, is an eruption on all parts of 
the skin. The inflamed skin throws out a crust or scab, which 
adheres closely, and after a few days is depressed in the mid- 
dle, and raised around the edges. After a considerable time, 
this scab falls off, and another forms in its place. These scabs 
are of considerable size, some of them nearly an inch in diame- 
ter. They multiply on all parts of the body, so that the quan- 
tity thrown off" is sometimes enormous. There is no discharge 
from this eruption, and the health of the patient is less affected, 
than might have been expected. It is, however, a loathsome 
and disfiguring disease, and no person affected with it will 
endure it longer than the direst necessity compels him. 

REMEDIES. 

Frictions with mercurial ointment and warm bathing should 
be tried in cases of leprosy. It is acknowledged that they fre- 
quently fail ; but I should still think this the best commence- 
ment of the treatment. The mercurial ointment should not be 
repeated more than once in four or five days ; but it should 
not be hindered of its effect by bathing on the same day after 
its application. If symptoms of salivation appear, let the oint- 
ment be discontinued. The internal use of arsenic is more re- 
lied on in this disease. Ten drops of Fowler's solution may 
be taken three times a day. If the disease does not give way, 
a trial should be made of mineral waters containing sulphur. 



itch. 685 

The Indian Springs in Butts county, Georgia, afford the best 
water I know, of this description. 



ITCH. 



The acarus, an exceedingly minute insect, is said to be the 
sole cause of this loathsome disorder. This insect, which I 
have neglected to search for, is said to be visible to the naked 
eye. It is active, and covered with a hard shell, and small 
enough to force its way into the skin through its natural pores. 
Satisfied when it is safe from dislodgement, it draws its nour- 
ishment from the body, and no doubt lives a life of ease and 
luxury. The irritation it produces causes itching, and has 
thus given name to the disorder. The small pustule which 
forms, is not the residence of the acarus. He sits securely en- 
sconced in the epidermis, hard by, and may amuse himself, 
-with the picking and searching ollen made in the pustule for 
him. He seems in fact to have as little use for these pustules 
as the patient. If you wish to find him, search a roughened 
spot near one of these pustules ; there open the skin with the 
point of a needle, and, if your eyes are very good, you will 
perceive a very small white body, which being laid on colored 
paper, will be plainly seen to move. This is the acarus or itch 
insect, and he is said to be so active, that it is not easy to de- 
stroy him with the point of a needle. It is said that the shell 
on his back is so hard, that it is not easily penetrated, and that 
he draws in his head and feet with great agility when he is 
touched. These observations I have not made myself, be- 
cause they are not easily made without a microscope, and 
I have not thought it important to verify them. They are 
unquestionably true, and worthy of remark, because of all 
the diseases of the skin, the itch alone owes its origin to a 
parasitic insect. 

REMEDIES. 

Sulphur is poison to the acarus, and therefore cures the itch. 
It has long been used by mixing it in lard, and rubbing it on 
the skin. The ill smell of sulphur, which is the more unpopu- 
lar from its known connexion with the itch, has caused many 
to fly to other remedies. JBut the sulphur is the best, and 
should be applied daily, for a week, if necessary. While wri- 
ting this article, I am taught by a friend, a more decent and 



686 FRECKLES. 

effectual way of using sulphur for the cure of the itch. Take 
a bucket of water, and throw into it an ounce or two of sulphur. 
Into this, dip a newly washed shirt and drawers, and rub them 
in the water till the sulphur is equally applied to every part of 
them. Dry them — put them on without ironing, and wear 
them a week. The itch will be cured, and the smell of sul- 
phur hardly perceived. But there are other remedies for the 
itch. The common mercurial ointment of the shops, will, if 
rubbed on the parts affected, destroy the disease in about a 
week. The citrine, or yellow ointment is also a good remedy. 
Either of these ointments may, if used too profusely, produce 
a salivation. To prevent this, the skin should be frequently 
washed, and the linen changed. A more cleanly mercurial 
remedy, is a strong solution of corrosive sublimate in spirit. 
This may be applied to the skin. It will cause some smart- 
ing, but no other evil. I will mention one more cure for the 
itch. Take about a pound of poke root phytolacca decondria, 
boil it in two quarts of water, till the root is beginning to be 
soft. Bathe with this decoction warm. This cures at a sin- 
gle application ; but it is the most painful, while yet it is the 
neatest of remedies. The effect it produces on the skin is so 
nearly like nettlerash, that it cannot be readily distinguished 
from that disease. It is to be used by those who are resolved 
to be rid of the itch ; and by those only. 



FRECKLES— YELLOW ERUPTION, &c. &c. 

There are several slight affections of the skin, which deserve 
a passing notice. 

Freckles are so easily produced on some persons, that no 
prudence can avoid them. They are increased by exposure 
to the sun ; and it has been suggested, that light, even in snowy 
weather, will cause them to appear. They are situated on the 
pigment of the skin in which the color or complexion resides. 
I regret to add, that no remedy for them has been discovered. 



YELLOW PATCHES— CHLOASMA. 

This affection is not uncommon, but has not obtained a com- 
mon name. It appears on the face in pregnant women, who 



GRUBS. 687 

recover from it after accouchment. On other persons, it is 
seen about the neck or breast, and is sometimes a blemish 
which it is desirable to remove. Stimulating washes, such as 
Cologne water or brandy, have been advised. Two grains of 
blue pill or a quarter of a grain of corrosive sublimate twice a 
day, are more entitled to confidence. The disease never pro- 
duces much deformity. 



GRUBS— COMEDONS. 

About puberty, the sebaceous glands of the nose and fore- 
head deposit a substance in the skin, which produces rough 
and pointed tumors, from which little bodies may be pressed 
by the finger nails. These bodies have been called worms or 
grubs. They are however, neither worms nor a sign of dis- 
ease ; and they will cease to appear after a year or two. They 
may be pressed out from time to time, and it is thought, that 
stimulating washes lessen and remove them. Cologne water 
may be used with as much pleasure as benefit. A solution of 
sulphate of copper applied daily, has been of great service in 
some cases. 



DISPENSATORY. 



If the reader had before him, the thirteen hundred and six- 
ty-eight pages of Wood and Bache's United States Dispen- 
satory, he would naturally wonder at the small number of 
articles, which I have thought it necessary to mention in 

my DISSERTATION ON THE PRACTICE OF MEDICINE. The young 

physician, will I apprehend, be a good deal surprised, that I 
have not recommended, a great many more, of the remedies 
which are acknowledged to be of sreat value. I have but one 
excuse to offer. I have found by experience, that success in 
the treatment of diseases, does not depend on the number of 
remedies used. I have been taught that, though the number 
of remedies is great, their modes of operation are few. And 
although I acknowledge, that there is in nature, a special adap- 
tation of certain remedies to the removal of certain diseases ; 
I believe that the discoveries of such remedies, are as yet very 
few. If we were limited in our prescriptions, to the use of 
such remedies only, as are known to have special power over 
the disease for which they are given, our " occupation" would 
be gone. Fortunately, the science of medicine is not thus 
limited. We combat the known and visible effects of disease, 
by opposing to them the known and visible powers of reme- 
dies. All that we can reasonably attempt, can be done with 
a small number of remedies. I can say with truth, that I have 
learned by experience, to rely on a few remedies of known 
value. Holding myself at all times, ready to accept with joy, 
any and every improvement in my favorite science ; I offer 
the following remedies, with great confidence, that they are 
the best we have ; and that they will prove sufficient in hands 
which are capable of using them properly. 

ADHESIVE PLASTER. 

It is a great object in the treatment of wounds and ulcers, 
to have plasters which adhere with sufficient firmness to the 
skin, to hold the parts together, and secure their perfect ad- 
justment and support. This is accomplished by Griffith's Ad- 
hesive Plaster, an article now I believe, sold by every drug- 
gist in the United States. This plaster should be kept in eve- 



DISPENSATORY. 689 

ry family. It is applied by being cut into strips, and after be- 
ing gradually warmed, drawn firmly on the part. This plas- 
ter adheres with sufficient firmness, and may yet be removed 
without much force. It does not soften from the moisture of 
the part, nor even by the free application of water. It should 
be known, that there is nothing in the quality of plasters, to 
promote the healing of wounds or ulcers. Healing is a pro- 
cess of nature, and when the impediments to it are removed, 
it takes place of itself. Any other plaster which will adhere 
as firmly, will answer as well as that I have recommended. 
I have seen a wound very well treated by laying on it strips of 
rag dipped in copal varnish. This forms a very adhesive 
plaster, but requires that the part should be kept still, till the 
plaster dries. It is objectionable on account of the oil of tur- 
pertine it contains, which renders it too stimulating. 

ALCOHOL. 

I will not fatigue the reader with the history of alcohol. This 
with its baneful effects, he has heard from a thousand tongues. 
It is my business to speak of it as a valuable remedy in the 
cure of diseases, and as a still more valuable article, in pre- 
serving, keeping, and preparing medicines for use. 

Alcohol is a light transparent fluid, of an agreeable odour, 
and of a pungent and burning, but not disagreeable taste. It 
is a powerful stimulant, and when taken in excess, produces 
temporary intoxication. In a portion still larger, it is a fatal 
poison. The intoxicating property of brandy, wine, porter, 
cider, and all other distilled and fermented liquors, depends 
on the alcohol they contain. 

The preservative power of alcohol, gives to it great value. 
A piece of flesh dropped into it remains sound for any length 
of time; medicines dissolved in it, are preserved unchanged, 
and many substances which it will not dissolve, are still ad- 
vantageously preserved by it. 

The value of alcohol as a medicine, is universally acknowl- 
edged. Too strong to be administered undiluted, it is taken 
in the form of distilled or fermented liquors. Brandy, wine, 
and porter, are the most valuable of these, and deep is the re- 
gret I feel in being obliged to say, that they are to be advised 
with due regard to the danger of their becoming by frequent 
use, a beverage too agreeable to be used with proper restric- 
tion. Experience warrants me, at the same time in saying, 
that the use of spirit, or wine, in the treatment of diseases, is 
44 



690 DISPENSATORY. 

very seldom the cause of habits of intemperance. I have seen 
men too fond of their bottle of bitters, but they were such as 
had no objection to a glass of grog without bitters. I have 
never met the man who could say to me, that he was made a 
drunkard by a physician's prescription. 

1 have said that excess in the dose of alcohol, would prove 
fatal. I witnessed a case of instant death in a child, from 
drinking brandy. It had gotten on a chair near a table, and 
had taken from a bottle a quantity of brandy, not more than 
half a pint. It was heard to fall, and was taken up, a lifeless 
corpse. Used in a gradual manner to produce exhilaration, 
its effects are slow, but destructive. 

Medical properties and tises. The uses of alcohol in the 
treatment of diseases, are many and important. It is, in 
its operation, a pure stimulant; more efficient in impart- 
ing to the system a temporary vigor and exhilaration, than 
any other. The most common form in which it is used, 
is distilled spirits. French brandy, as we term the bran- 
dy distilled from wine, is considered the most palatable. I 
know of no reason why it should have a decided preference, 
over other good spirit. Half an ounce, or a common table 
spoonful, is a reasonable portion to one unaccustomed to its 
use, but a larger quantity may be safely taken. To persons 
who are debilitated, from whatever cause, if there is no inflam- 
mation present, a moderate use of spirit of this description is 
beneficial. The most temperate, and healthy men I have 
known, have taken before breakfast and before dinner, a mode- 
rate drink of brandy and water. But fashion has dispensed 
with the morning, and increased the dinner portion. But it is 
only the sickly and debilitated, who should use this article as 
a beverage. Its use in excess, cannot be too much depre- 
cated. 

As a remedy in acute diseases, alcohol is invaluable, and its 
place cannot be advantageously supplied by any other. When 
from the sudden onset of disease, the system is prostrated, the 
face pale, pulse feeble, and extremities cold, brandy in quan- 
tities proportioned to the violence of the case, is often a power- 
ful remedy. When a similar prostration takes place from vio- 
lent fatigue, or exhaustion, it is equally proper. The quantity 
which may be required in such cases, cannot be accurately de- 
fined. From half an ounce to two ounces in sugar and water, 
may be taken at a time, and repeated hourly till the desired 
effect is produced. In diseases which have a definite course 
to run, such as fever, small-pox, &c, there comes on at the 



DISPENSATORY. 691 

close of dangerous cases, a state of exhaustion, in which this 
remedy is superior to all others. 

ALOES. 

This is a very important medicine, and several varieties 
are met with. That most commonly used in this country, is 
produced on the Cape of Good Hope, and imported into the 
United States from England. It is a solid gum, of a dark and 
shining greenish color. The other varieties of aloes, do not 
differ very widely from this, and the medical properties of all 
are about the same. 

Medical properties and uses. Aloes is a cathartic of pecu- 
liar properties. It is mild in its operation, producing dis- 
charges from the bowels, which are rather solid than fluid ; 
operating about as freely in moderate as in considerable 
doses, and leaving the bowels excited to further action 
without medicine. These properties it possesses, in a de- 
gree so eminent, that few inventors of patent cathartic 
pills, venture to leave it out of their secret compounds. 
It is at the same time a general stimulant, and produces when 
too frequently used, great excitement of the rectum and neigh- 
boring parts. Aloes is also an emenagogue, producing mani- 
fest increase in the menstrual discharge. These properties 
give to this article an importance, attached to few others. Giv- 
en in small and frequent doses, it removes costiveness and pro- 
motes digestion ; it promotes the flow of the menses, and is 
therefore, of great value in the treatment of diseases attended 
with the obstruction of that discharge. Its indiscriminate use 
has been productive of great mischief. It is improper in all 
inflammatory disorders, and particularly so, in piles and other 
disorders of the rectum. It is also hurtful to females, whose 
menstrual discharge is commonly excessive. The dose of 
aloes is from three to ten grains — even twenty grains may be 
safely given, but such a dose is seldom requisite. It is sel- 
dom advisable to give it alone, and it is beneficially combin- 
ed with other, and less heating articles. The most conve- 
nient method of giving it is in pills. 

ALUM. 

This common article is a neutral salt composed of sulphuric 
acid, combined with clay and a small portion of potash. It is 
found in certain ores, and prepared by dissolving it in water, 
and evaporating the solution. 



692 DISPENSATORY. 

Medical properties and uses. Alum is a powerful styptic 
and astringent, free from all poisonous qualities, and there- 
fore doubly valuable in common hands. Given internally, 
its tendency is to arrest the discharges by the bowels, to 
suppress hemorrhage, and in general to perform all the offi- 
ces of an astringent. To effect these objects it should be 
given in small doses — from three to ten grains once in three 
or four hours. In larger doses it operates as a cathartic ; and 
has great reputation for its beneficial effects in painter's colic. 
From thirty to sixty grains, given every two hours, will ope- 
rate as a cathartic. In still larger doses, it is an emetic. 
From one to two drachms given every five minutes in water, 
is a prompt and safe emetic. I have given it with great ad- 
vantage in certain cases of croup. Now all these effects can 
be brought about by the use of alum when the modes of ad- 
ministering it are properly understood ; but there is in the use 
of it, another great advantage in its safety. As an external 
application, alum is still more important. In certain diseases 
of the mouth and throat, where there is ulceration or raw sur- 
face, it is a read} 7 and effectual remedy. Used as a gargle, 
by dissolving it in water, or in sage tea, it is very effectual in 
arresting the diseased action. For this purpose, a drachm of 
alum may be dissolved in half a pint of water or tea. As an 
application to fungous, or proud flesh, its use is gene- 
ral. For this purpose, it is commonly burned and powdered ; 
but it is unchanged by this process, and answers the same 
purpose if simply powdered. It should not be applied too of- 
ten, as it will hinder the healing of the ulcers. 

ARSENIC. 

This dangerous poison, is also a remedy which it would be 
improper for us to discard. I recommend only a single prepa- 
ration of it ; but think it proper to remark, that this poison 
is fatal if taken in too large doses internally, and very un- 
safe as an external application. Two or three grains taken 
internally, would be dangerous to life. Applied externally, it 
is a powerful escharotic, but liable to be absorbed and produce 
permanent injury. It has performed many wonderful cures, 
but should only be directed by an experienced physician. 

ARSENICAL SOLUTION. 

This remedy is sold by our druggists, and the mode of pre- 
paring it is uniform. It is known by the name, of Arsenical 



DISPENSATORY. 693 

solution or Fowler's solution. This remedy is given with 
great advantage in obstinate ague and fever, and in several 
diseases of the skin. The dose is from five to ten drops, and 
may be repeated two or three times a day. It should not be 
continued more than a week or ten days without some inter- 
val, for fear of producing paralysis, tremors, or other nervous 
disorders. A swelling of the feet like dropsy, sometimes arises 
from its use ; but this has never resulted in any permanent in- 
jury, so far as I have observed. 

ASAFETIDA. 

Asafetida is a resinous gum of a reddish brown color, and 
very offensive smell. It is said to be obtained from Persia, 
though it reaches us through the English commerce of India. 

Medical properties mid uses. Asafetida is a powerful antispas- 
modic and moderate stimulant, and if given in large doses, a 
mild laxative. Its offensive odour, which resembles, but far 
exceeds that of garlic, has a tendency to limit its usefulness. 
There are many complaints in which it is the best remedy in 
our possession. Its greatest influence is exerted in hysterical 
and nervous disorders. In spasmodic and convulsive diseases, 
it is also given with advantage ; and in diseases of the lungs, 
where there is difficulty of breathing from spasm, or palpita- 
tion of the heart, it is a valuable remedy. Its influence on the 
healthy action of the system, is so agreeable, that persons who 
use it acquire a fondness for its taste and smell, and it is said 
that in the country in which it grows, the plant which produ- 
ces it, is eaten by men as well as other animals. I ought not 
to omit to mention, that it has had great reputation as a reme- 
dy in hooping cough, and in the dry cough which is frequently 
met with in old persons. The dose of asafetida is about ten 
grains, and it may be given safely in doses of twenty or thirty 
grains, but such doses may prove cathartic. The most con- 
venient way of giving it, is in pills, but it is also made into a 
tincture, of which from thirty drops to a tea spoonful may be 
given in water. 

AMMONIA. 

Ammonia in its pure state is a transparent gas, with power- 
ful alkaline properties. In medicine, it is used in its various 
combinations, with acids with which it forms solid salts, and 
with water or alcohol in which state it is fluid. In its combi- 
nations idth various acids, it acquires properties so widely 



694 DISPENSATORY. 

different, that it requires close observation and experience to 
use them safely. In combination with carbonic acid, it retains 
in a great degree its alkaline properties, but when combined 
with muriatic acid, it is a neutral salt. Although ammonia in 
several of its combinations, has been long considered a stand- 
ard article of medicine, it is but lately, that its peculiar rela- 
tion with animal matter has attracted much attention. In the 
forms we most frequently use it, we are liable to be disap- 
pointed in its effects, by its readines to form chemical com- 
pounds with the fluids of the body. These combinations we 
can neither foresee, nor can we well estimate their consequen- 
ces if we do foresee them. The subject is one of deep inte- 
terest, and I look forward to the time, when this article is to 
assume an importance in medicine which is little expected. 

Medical properties and uses. In the water of ammonia, we 
have this medicine, in its purest and most available state. 
This article is known in commerce by the common name of 
spirit of hartshorn. It is a transparent pungent fluid, and in 
general use as a sternutatory. In over doses it is a corrosive 
poison ; but in doses of from ten to thirty drops, largely dilu- 
ted with water, it is a valuable stimulant qualified to arouse 
the energies of the body, without oppressing the brain or ner- 
vous system. Applied to the skin, it produces redness, pain, 
and if long continued, blistering. A more elegant preparation 
of this article, is the aromatic spirit of ammonia. This is gene- 
rally preferred to the water of ammonia on account of its 
agreeable flavor. It may be given in doses of from twenty to 
sixty drops. The muriate of ammonia has not been much 
used as an internal remedy in this country. On the continent 
of Europe, it is said to be now used extensively in several 
chronic disorders, particularly such as affect the liver and 
spleen. It has beefi recommended in many diseases, but I 
have seldom known it used. The dose is from five to thirty 
grains repeated several times a day. 

After all our investigations, it must be acknowledged, that 
our knowledge of the medical properties of ammonia is very 
limited. It is an article of deep interest, and worthy of close 
observation and study. 

BALM. 

This is a perennial plant, and being considered medicinal, 
is to some extent cultivated in our gardens. It is a mild and 
very gentle stimulant, and favors the flow of perspiration. It 
may be used when its flavor is more agreeable than other ar- 



DISPENSATORY. 695 

tides, but I do not consider it a medicine. It has an agreea- 
ble flavor when green, but loses it in drying, and is therefore 
only lit for use when freshly gathered. It may be beneficially 
used, in infusion or tea, during the administration of sweating 
medicines. This infusion has been extensively used by the 
sick in febrile diseases, and there is nothing more innocent in 
its effects. 

BLACK HELLEBORE. 

This is a famous medicine of the ancients, who used it in 
many diseases. It is a perennial plant, and the root is the part 
used. In large doses it is a drastic emetic and cathartic, and 
sometimes productive of dangerous symptoms. Its efficacy 
in promoting the menstrual discharge, is the only quality which 
preserves for it a place in the practice, and even this power is 
disputed. My own opinion is, that it is a powerful emena- 
gogue> and has in particular cases an activity not easily ex- 
plained. To some persons who have painful and deficient 
menstruation, this remedy effects every thing which could be 
desired of it, while in others apparently under the same cir- 
cumstances, it signally fails. The preparation of black helle- 
bore which I recommend, is the tincture, and this should al- 
ways be prepared by the druggist. The dose is from thirty to 
sixty drops two or three times a day. It should not be con- 
tinued more than three or four days at one time. 

BLUE STONE. 

The sulphate of copper, or blue stone, is an article of too 
mucltoctivity, to be used as an internal remedy, unless it had 
particular powers which other remedies do not possess. Not 
believing it to possess these powers, I do not recommend it as 
arj internal remedy. Applied externally, I consider it an arti- 
cle of considerable value. A solution of about two grains in 
an ounce of water, is a valuable remedy in inflammation of the 
eyes. It may be applied by dropping into the eyes once or 
twice a day. A solution of twenty grains to the ounce is of- 
ten beneficial to indolent ulcers. Applied by means of lint 
dipped into it, and laid on such ulcers, a rapid change is often 
brought about, and healing accomplished. In various species 
of tetter, this is also a good remedy, but when there is much 
sensibility, it is a painful application. 



696 DISPENSATORY. 

BORAX. 

The medical virtues of borax, have been less investigated 
than its value would justify. It is a mild neutral salt, refrige- 
rant and diuretic in its effects, and thought to be also a valua- 
ble emenagogue. It is free from poisonous qualities, and may 
be given internally in doses of from ten to thirty grains. But 
I have seen but little of its use except as a detergent in certain 
ulcers. In thrush or other forms of sore mouth in children, it 
is a valuable remedy. Take two drachms of borax in fine 
powder, and mix it with an ounce of syrup or honey. Apply 
this to the ulcers twice a day. In diseases of the skin, such as 
tetter, or ringworm, a strong solution of this article may be ap- 
plied two or three times a day with benefit. It has the advan- 
tage of mildness and safety, and should be used oftener than I 
have been in the habit of seeing it done. 

BURGUNDY PITCH. 

This article is only used as an external application. Spread 
on cloth or on fine leather or buckskin, it forms an adhesive 
plaster, which will adhere firmly for many days. Its effect is 
to stimulate, and redden the skin, and in some cases to excite 
considerable irritation and blistering. It is beneficial as a 
strengthening plaster when applied to the back of debilitated 
persons. Applied to the breast, it is often beneficial in remov- 
ing chronic pain. It should be obtained from the apothecary 
when wanted, as it is not easy to preserve it for a great length 
of time. 

CAMPHOR. 

Camphor, although a solid substance, resembles in its com- 
position and medical properties, the essential oils. As a mild 
and agreeable aromatic, it is in the hands of every one. As a 
remedy for internal use, its properties are a matter of great un- 
certainty, some classing it with the most powerful stimulants, 
while others regard it as a sedative. I have prescribed it ve- 
ry often, and offer my opinion without claiming for it any par- 
ticular respect. 

Applied to the skin, dissolved in alcohol or proof spirit, it is 
a mild stimulant and comforting anodyne. It is useful in rheu- 
matic pains, and other disorders producing local pain. The 
odour inhaled, is not only agreeable, but in a high degree ex- 
hilarating, and more beneficial in cases of fainting or sudden 



DISPENSATORY. 697 

prostration, than any other article with which I am acquaint- 
ed. As an internal remedy, it is a mild stimulant and gentle 
anodyne, and promotes perspiration in a remarkable degree. 
Its elfects vary with the mode of* administering it. In doses of 
from three to five grains once in two hours, it is a gentle ano- 
dyne, and gives a moderate support to the system, without 
producing any exhaustion afterwards. In larger doses it flush- 
es the face, increases the force and frequency of the pulse, and 
produces some confusion of intellect. If the dose is increased 
to twenty grains and repeated, it will produce vertigo and 
deep sleep or delirium. I have known an over dose produce a 
sudden vomiting, followed by a total prostration of strength, 
which in a few minutes resulted in a deep sleep, from which 
the patient could not be aroused for many hours. This is the 
worst evil I ever witnessed from the use of camphor, and con- 
sidering it as a remedy in universal use, I could not say more 
in proof of its great safely. The remedy is freely recommend- 
ed to the common reader, in low, nervous, and hysterical dis- 
orders ; and as a stimulant in the low stage of typhoid fever* 
To those who without being very ill, find it necessary to use 
some stimulant, camphor commends itself as an article which 
was never known to be the foundation of intemperate habits. 

CASTOR. 

Castor is an animal substance, derived from the beaver, and 
resembles musk in its medical qualities. It is a dark brown 
substance, of disagreeable odour, and of an acrid nauseous 
taste. Its medical virtues are extracted by alcohol, and it 
may be administered in substance or in tincture. 

Medical properties and uses. Castor is a nervous stimulant, 
and may be given with great advantage in hysterical and 
other nervous and spasmodic diseases. It is thought to pro- 
mote the menstrual discharge, and has been much used in fe- 
vers of a low grade. The dose in powder, is ten or fifteen 
grains ; but it is oftener given in tincture, in doses of from 
twenty to sixty drops. I think castor a remedy of great value 
in nervous diseases, and in hysteria, it is second only to asa- 
fetida. 

CASTOR OIL. 

This remedy is a fixed oil, obtained from the seeds of the 
palma christi ; a plant originally from the East Indies, but 
now familiarly known in the Southern and Western States. 



698 DISPENSATORY. 

The best castor oil is obtained by pressure, and is known by 
its pale color, and mild inoffensive smell. It should be trans- 
parent, colorless, and nearly tasteless. 

Medical properties and uses. Castor oil is a mild, but very 
efficient cathartic. It is highly esteemed for the ease and 
briskness of its operation, and is given to pregnant women, 
and to persons affected with diseases requiring the free dis- 
charge of the contents of the bowels with the least pain and 
irritation. Children take it with great safety, and require do- 
ses, larger than would be suited to their ages, when the proper 
dose for grown persons is considered. Great care should be 
taken in procuring oil that is good, and free from the clouded 
and muddy appearance sometimes seen in it. Such oil is apt 
to produce griping and intolerable sickness during its opera- 
tion. The dose of castor oil, is two table spoonsful or a fluid 
ounce. A child six years old may take a table spoonful. 
These doses may be repeated every two or three hours if ne- 
cessary. 

CATAPLASMS. 

Cataplasms, or poultices, are medicines for external appli- 
cation. They should be made of substances sufficiently ad- 
hesive to remain on the part they are applied to, but soft and 
moist enough, to be removed at pleasure. It is no longer be- 
lieved that they possess medical powers at all corresponding 
with the qualities of their ingredients. There are some arti- 
cles — tobacco for instance, which applied in this way, affect 
the system generally ; but such articles should, if used at all, 
be given in doses well ascertained, and by no means applied 
in a way so uncertain as in poultices. As a general rule, poul- 
tices should be made of substances mild and inert, and quali- 
fied to produce softness, warmth, and moisture. If a stimula- 
ting effect is desired, it is best obtained by adding a portion 
of powdered mustard or cayenne pepper. The whole bene- 
fit of poultices or cataplasms, can be obtained by those made 
of crumb of wheat bread, Indian corn meal, flax seed meal, or 
the powdered bark of slippery elm. 

CATHARTICS. 

I have neither time, nor room, to treat of this subject ac- 
cording to its merits ; but I consider it a sacred duty to warn 
the world at large against the abuse of remedies of this class. 
The effect of cathartics, is to cause discharges from the bowels; 



DISPENSATORY. 699 

and these discharges are in several ways altered by the ope- 
ration of these remedies. Persons readily conclude that, if a 
cathartic produces offensive discharges, it of course does them 
good, and ought to be repeated. Millions are annually ex- 
pended for quack remedies, from reasoning so weak and faul- 
ty as this. Others a little wiser, know that the feculent mat- 
ter which is proper to the bowels, may be offensive to the sen- 
ses. They avoid the. use of cathartics, except their bowels be- 
come a little torpid. They do not know what degree of cos- 
tiveness may be compatible with health, and swallow pills, as 
they think to assist nature. Thus they begin a career of pill- 
taking, to which they may not easily find an end. Let it be 
borne in mind, that taking a cathartic is not an act of indiffer- 
ence. It should be done, only when it is necessary, and not 
repeated, if it can be avoided. 

The articles which produce a cathartic effect, are almost in- 
numerable. They have peculiarities, and are divided into 
classes. The most active are called drastic, and are used to 
procure the most copious discharges from the bowels. Jalap 
is an example of these. Hydragogue cathartics produce co- 
pious watery discharges. The varieties of salts are of this 
description. The mild and stimulating cathartics, excite the 
bowels to discharge their contents, and are for common use, 
by far the least objectionable. Castor oil, rhubarb, senna, and 
aloes are remedies of this description. These may be taken, 
with more freedom, and repeated with less injury, than almost 
any others with which I am acquainted. 

BALSAM OF COPAIBA. 

This is a peculiar resinous substance, obtained from a tree 
which is the growth of several countries. It is a transparent 
fluid, of an oily appearance, and has a disagreeable odour and 
nauseous taste. It is a valuable remedy, because its action is 
well understood, and we have no other substance at all to com- 
pare with it in producing its peculiar effects. 

Medical properties and uses. When swallowed, the balsam of 
capaiba produces an irritating and burning heat in the throat, 
which, if the dose is large, extends downwards to the bowels, 
producing more or less griping and cathartic operation. It 
also produces an increased secretion of urine, and a decided 
effect on the whole mucous surface of the bladder and ure- 
thra. If continued in large doses, it is exhaled from the lungs, 
and may be smelled in the breath ; and it produces a strong 



700 DISPENSATORY. 

impression on all the mucous surfaces of the body. Finally, 
it produces in some cases, an irritation on the skin, which is 
compared by some to measles, and by others to nettlerash. 
But this effect is not often produced by it. These properties 
give to balsam copaiba a decided place in the treatment of se- 
veral diseases. In disorders of the mucous surfaces of the 
lungs and intestines, it is a valuable remedy, but requires judg- 
ment in its exhibition, and frequently disappoints our expecta- 
tions. In affections of the urinary organs, it is often our best 
remedy. In gonorrhoea, and in many cases of leucorrhcea and 
gleet, it is decidedly our best remedy. It is not forbidden by 
the presence of inflammation, unless it extends beyond its usu- 
al range in these diseases. There are few articles of the ma- 
teria medica, the loss of which would be more seriously felt. 
The dose of balsam copaiba is from twenty to sixty drops, and 
it may be repeated three or four times a day. 

CUBEBS. 

This medicine is composed of the seeds of an Eastern climb- 
ing plant, and in its appearance very much resembles black 
pepper. It is a moderate, and not ungrateful stimulant, and 
besides being diuretic, operates as a general stimulant of the 
mucous surfaces. It is a valuable remedy in gonorrhoea, gleet, 
leucorrhcea, and in some affections ot the kidneys and bladder. 
The dose is a drachm or more, when given in gonorrhoea ; but 
in cases of chronic cough or other diseases unattended with 
inflammation, it may be given in smaller doses and continued 
longer. 

emetics. 

The disagreeable and revolting effect of emetics, has hin- 
dered them from being the foundation of a thousand quack 
medicines, and thus very much benefited the world. They 
are, in their place, of great value. The articles which will 
cause the ejection of the contents of the stomach, are very nu- 
merous ; but in the practice of medicine, a very small number 
are used. Some of them act with great promptness, causing 
the contraction of the stomach and throwing off its contents 
without producing any further effect. The article of this char- 
acter which is most frequently used, is sulphate of zinc or 
white vitriol. It is used for the rejection of poisons from the 
stomach, as well as for the cure of diseases. In the treatment 
of diseases, ipecacuanha and tartar emetic, are considered the 



DISPENSATORY. 701 

best. The ipecac is the mildest, but produces its effect with 
great certainty, operating also as a mild cathartic when not 
thrown off from the stomach. Tartar emetic is much more 
powerful, and is unquestionably one of our best remedies. It 
is not very prompt in its action, but produces great nausea and 
profuse perspiration, as well as a powerful emetic action. In 
small doses at long intervals, it produces nausea, and finally 
operates as a cathartic. It is a powerful sedative, and useful 
in many dangerous inflammatory disorders. 

ERGOT. 

This is a remedy derived from a disease of grain, particu- 
larly rye ; in which it produces an enlargement and alteration 
of the grain, which is well compared to a cockspur. 

Medical properties and uses. The sensible effect of this reme- 
dy, when taken in small doses by men, is scarcely to be no- 
ticed. In large doses — an ounce or more, it produces stupor 
or vertigo, with great prostration of strength, and weakness of 
the pulse. When from its occurrence in the rye, of which the 
bread of the poor in Europe is made, it has been taken in large 
quantities, wide-spread disease, with gangrene and other dan- 
gerous symptoms, has prevailed. 

All these qualities in ergot would not have obtained for it a 
place in our small dispensatory ; but for one quality, which 
fully entitles it to our notice. A drachm of powdered ergot, 
divided into three doses, and one given to a female every fif- 
teen minutes, will produce a powerful and painful contraction 
of the uterus, which will last for some time. This specific ef- 
fect of ergot is a well established fact, although it does not hap- 
pen in every instance. The remedy is now well established, 
and in daily use for increasing the pains of labor, to promote 
the birth of the child, when nature in her own movements is 
too slow. This is the principal use of ergot; but its adminis- 
tration requires judgment, and it should not be given, except 
by the advice of a physician. 

ETHERS. 

" Ethers are peculiar, fragrant, sweetish, very volatile, and 
inflammable liquids, generated by the action of acids on alco- 
hol." The ethers most used in medicine are the sulphuric and 
the nitric. 



702 DISPENSATORY. 

SULPHURIC ETHER. 

In common language the term ether, is used to signify sul- 
phuric ether. Taken internally, this is a powerful diffusible 
stimulant,' but it is transient in its operation. It is used in 
painful and spasmodic diseases. The dose is from forty drops, 
to a tea spoonful ; but it evaporates so rapidly, that it ought 
not to be given in drops, but rather by measure. The proper- 
ty of producing giddiness, intoxication, and stupor, by being 
inhaled, has lately been a good deal noticed, in sulphuric ether. 
The effect it produces is very decided, and wants only a 
knowledge sufficient to regulate its force, to become an impor- 
tant remedy. I have administered it, by pouring it on a hand- 
kerchief and applying it to the nostrils, and have found it to 
relieve the most violent pain in a few minutes. In the same 
way, I have seen it used to destroy sensibility, that operations 
in surgery might be performed without inflicting pain. In 
some of these experiments, it has been entirely successful, and 
I see no reason, why it should not continue to be used in this 
way. It is considered less dangerous than chloroform. 

SWEET SPIRIT OF NITRE. 

This is the spirit of nitric ether, but sufficiently known by 
the above title. 

Medical properties and uses. This mild diuretic, and excellent 
sudorific is much esteemed in medicine. It may be safely 
used in fevers, and is not forbidden by a full pulse and great 
heat. The dose is a tea spoonful once in two or three hours, 
and when it is given as a diuretic, it may be given in larger 
doses. It may be combined with other remedies or given 
alone. 

GALLS. 

Galls are excrescences formed on the tender shoots of the 
oak, by the puncture and deposite of its eggs, by an insect. 
The gall is at once the nest and the nutritive food of the young 
insect ; those met with in commerce, are produced on a di- 
minutive tree of the East. 

Medical properties and uses. The oak gall is a valuable as- 
tringent medicine, containing in a concentrated form the tan- 
nin which is the most active ingredient in the bark of the vari- 
ous kinds of oak. As an internal remedy, it is considered a 
pure astringent, and much relied on for the relief of chronic 



DTSPENSATORY. 703 

diarrhoea, and other wasting discharges. It is said to arrest 
the operation of tartar emetic s>oner than any other remedy. 
As an external remedy, it is valuable for the destruction of 
fungous flesh, and especially so, in the proud flesh which often 
arises on burns. It forms a valuable ingredient in gargles, 
and in injections used for gleet and leuchorrhoea. The dose of 
powdered galls, is from ten to twenty grains, to be repeated 
several times a day. 

GAMBOGE. 

This is a gum resin, obtained from China and other coun- 
tries of the East. It is a hard brittle substance, and when re- 
duced to powder or united with water, of a beautiful yellow 
color. 

Medical properties and uses. Gamboge is a powerful hydra- 
gogue cathartic, and very apt to produce vomiting when given 
in a full dose. It is a valuable remedy in dropsy, and in cases 
of obstinate constipation. In combination with other cathar- 
tic medicines, its action is modified ; and it is one of our most 
valuable cathartics. With aloes it forms a mild cathartic ; 
with calomel it is more active ; and with jalap it is one of our 
best remedies for drops} 7 . The dose of gamboge is from two 
to six grains, and it may be given in pills or in powder. 

GENTIAN. 

The tribe of plants known by the name of gentian, are re- 
markable for their bitterness, and several varieties are thought 
to be almost identical in medical properties. There are two 
kinds known at the South, one with blue flowers, growing on 
wet clay bottoms, and the other with pale whitish flowers, 
growing on high sandy hills. Their branching fleshy roots are 
scarcely distinguishable from each other, and their taste and 
medical properties are about the same with the gentian of 
commerce. The yellow gentian of which we are now to 
speak, is a plant of the mountains of Europe, differing from 
the rest of its kind, in being larger and probably more abun- 
dant. The root only is used in medicine. 

Medical properties and uses. Yellow gentian is a pure bitter, 
with nothing to distinguish it from other bitter plants, except 
the purity of its bitterness. As a medicine, it is in a high de- 
gree tonic, and to such as are accustomed to it, agreeable to 
the taste. I think it possesses all the virtue as a medicine, 
which is to be found in plants which are merely bitter in their 



704 



DISPENSATORY. 



taste. It is with good reason that it is preferred to other plants, 
for the formation of bitters, and infusions for debilitated per- 
sons. It furnishes the bitter ingredient in our best tinctures 
or bitters — is conveniently used in infusion or decoction, and 
when boiled down, furnishes an extract easily made into pills, 
which contain all its virtues. It is in fact the chief of bitter 
medicines, and there is very little benefit in having many ar- 
ticles of this description. The dose of the root in powder is 
about thirty grains ; the dose of the tincture is from one to 
three drachms, and of the extract, from five to ten grains. 

GUM ARABIC. 

The acacia gum is the product of a thorny tree of the san- 
dy deserts of Asia and Africa. It is a pure gum, but without 
any medical properties. It is however, in several respects, 
useful to the sick. An ounce of it, put into a pint of boiling 
water, makes a mucilage which is not unpalatable, and is 
much used as food in inflammatory disorders. It is the light- 
est of food, and not entitled to much preference over other ar- 
ticles. In compounding medicines, its tenacious quality is 
available in the making of pills, and in making mixtures with 
water. It is also used in mixtures for coughs, which depend 
on irritation about the throat. But the value of this article, is 
greatly enhanced by the fact, that it neither decays nor alters 
by keeping. A powder of gum Arabic if kept dry, may be 
relied on after the lapse of years. 

IODINE. 

" Iodine is a soft, friable, opaque substance, in the form of 
crystalline scales, of a bluish-black color, and metalic lustre." 
When moist, it evaporates in the open air, producing a dense, 
heavy, purple, vapor. It is an elementary substance, obtain- 
ed from the ashes of certain saline plants by a difficult chemi- 
cal process. It enters into combination with many substances, 
and especially with the metals. 

Medical properties and uses. It is not yet forty years since the 
discovery of iodine; but its extraordinary properties have been 
to physicians, a subject of unremitted attention, and it is now 
universally acknowledged to be a remedy of great value. Its 
effects as a medicine, it may be readily supposed, have not 
yet been fully ascertained, and great diversity of opinion yet 
prevails in regard to them. Some of its very important effects, 



DISPENSATORY. 705 

may be considered as sufficiently established. Taken inter- 
nally, in moderate doses for a length of time, it produces great 
activity in the absorbent vessels, ca .sing tumors of various 
kinds to disappear. This power is especially manifest in goi- 
tre, which disappears under its use with great rapidity. Giv- 
en in excess, and too long continued, it has caused the entire 
absorption of the female breast, and also of the testicles of the 
male. But these accidents are so rare, that I have never seen 
either of them. This power of causing the absorption of the 
solid matter which has been deposited by disease, has attended 
the use of iodine in many disorders, especially scrofula and 
syphilis. As an external remedy, its powers are acknowledg- 
ed to be of the first importance. It is thought to be readily ab- 
sorbed through the skin, producing not only a powerful local 
effect, but operating generally on the system. The excite- 
ment it produces on the skin is immediate, and easily carried 
up to the point of blistering. It is also thought to produce a 
general excitement of the powers of life, increasing the diges- 
tive functions and geneial health. Its combinations with iron, 
with mercury, and with potash, are becoming standard reme- 
dies of decided value. The dose of iodine is from half a grain 
to two grains, once or twice a day. I am in the habit of ma- 
king a tincture, by dissolving forty grains of iodine in an ounce 
of alcohol, and giving from ten to twenty drops twice a day. 
I apply the same tincture externally with a feather, but it is to 
be desisted from when the skin acquires an orange color ; oth- 
erwise, considerable pain and blistering take place. If too 
large a dose of iodine is taken, and great burning at the stom- 
ach ensues, starch should be swallowed without delay. Its 
action on the skin is also instantly arrested by the application 
of starch. The preparations of iodine ; especially its combi- 
nations with mercury and iron, are to be preferred in most 
cases, to its use alone. 

IRON. 

Iron is the most extensively diffused of the metals, and is 
above all others distinguished for its usefulness in the arts of 
life, and value as a medicine. It has long been known as a 
remedy ; its preparations being powerfully tonic, raising the 
pulse, increasing the appetite, and increasing the coloring mat- 
ter of the blood. They are useful in diseases attended with 
debility, more especially those which are brought on by exces- 
sive discharges. They are used in cachexias, chlorosis, hyste- 
ria, dyspepsia, scrofula, and other diseases requiring reme- 
45 



706 DISPENSATORY. 

dies, restorative and strengthening in their qualities. It is giv- 
en as a remedy in its metalic state, or in chemical union with 
other bodies. Its combinations with oxygen, are the most com- 
monly used, but with acids and with alkalies, it also forms 
compounds of great value. All of its compounds are distin- 
guished by their freedom from all poisonous qualities. It may 
be proper to mention the doses of a few of its preparations. 
The dose of sulphate of iron is from one to five grains. If 
dried for making into pills, the dose is less by one third. The 
subcarbonate is given in closes of from five to thirty grains. 
The precipitated carbonate of iron, may be given in the same 
dose, and the muriated tincture may be given in doses of from 
ten to thirty drops. 

JALAP. 

Jalap is the root of a climbing plant, and is chiefly obtained 
from the province of Vera Cruz, in Mexico. It is a standard 
remedy, and extensively used in all parts of the world. 

Medical properties and uses. Jalap is a powerful cathartic, 
operating briskly, and producing copious watery discharges. 
Given alone, and in large doses, it produces griping pains, 
and if the dose is too large, its operation may be too violent to 
be safely risked. It is therefore commonly combined with 
some milder cathartic. With calomel, it forms a cathartic, 
which has probably been more used at the South, in the treat- 
ment of bilious fever than any other. United with cream of 
tartar, it is a powerful remedy in dropsy, and useful in acute 
inflammatory disorders of the brain, and other important or- 
gans. It is improper in diseases of the lungs. The dose of 
jalap is from twenty to forty grains. With calomel a common 
dose is ten grains of calomel, and twenty of jalap — with cream 
of tartar, fifteen or twenty grains of jalap, and two drachms of 
cream of tartar. Powders of this size may be repeated once 
in three or four hours, till they operate. 

KINO. 

There are several varieties of this medicine, which are ob- 
tained from various countries. It is uncertain whether it is all 
derived from the same variety of tree or not. It is neverthe- 
less a medicine of properties sufficiently uniform, and as a 
remedy decidedly valuable. It is a gum resin, of a reddish 
brown color, easily reduced to powder, and kept for a length 
of time without injury. 



DISPENSATORY. 707 

Medical properties and uses. Kino is a powerful astringent, 
and beneficial for the suppression of excessive discharges. It 
is a valuable remedy in chronic diarrhoea, and may be used 
for the suppression of hemorrhage. It may be applied exter- 
nally or taken internally. The dose is from ten to thirty 
grains, or it may be given in tincture, in doses of from thirty 
to sixty drops. 

XAP1S CALAMINARIS. 

This is the common name of the impure carbonate of zinc, 
an article which I have found very useful as an external ap- 
plication. It should be in an impalpable powder of a pale 
pink or reddish color. It is almost inert in its properties, but 
to raw surfaces and on ulcers which are inclined to form proud 
flesh, it is an excellent application. It is most conveniently 
applied, by sifting it through gause or thin muslin. It gives no 
pain, and may be used with great freedom. 

LIME. 

Lime is an abundant product of nature, but never found 
pure. For medical purposes it is only necessary to burn, or 
heat to redness, the rocks containing it, and afterwards to 
throw on them a sufficient quantity of water to slake them. 
By this means, they will be reduced to a fine greyish white 
powder. This is quick lime, a substance having great resem- 
blance to the alkalies, and in medicine to be used in the same 
manner. 

Medical properties and uses. Lime is a powerful antacid, and 
is in some degree styptic in its qualities. It dissolves in about 
seven hundred times its weight of cold water, and in this state 
is given in doses of a table spoonful, or more, to correct the 
acid, which is sometimes in excess in the stomach. It is often 
combined with milk, and this forms a valuable remedy in d}'S- 
pepsia and other disorders attended with feeble digestive pow- 
ers. As an external application, it is sometimes used in ill 
conditioned ulcers, and combined with corrosive sublimate it 
forms the black wash of the shops, which is still a favorite ap- 
plication for the same purpose. Lime water is formed by put- 
ting three or four ounces of quick lime in a gallon of water. 
The water is to be poured off for use, but the lime still left in 
the bottom. Its rapid combination with carbonic acid, ren- 
ders it difficult to preserve, and it should be made anew from 
freshly burnt lime frequently. 

In a solid form, lime is used in combination with carbonic 



70S DI3PEXSAT0RY. 

acid. Several preparations of about the same qualities are in 
use. Tae prepared chalk is the best. This remedy is used 
for the same purposes with lime water. It may be eaten, or 
combined with mucilage, united with such other medicine- 
may be desired. From ten to twenty grains may be taken, 
and repeated as circumstances require. 

IXXAR CAFSTIC, 

This article is composed of a combination of silver with ni- 
tric acid, forming a nitrate of silver, and this should be its com- 
mon name. In its pure state, it is a crystalized salt of a white 
color, but is commonly met with in cylindrical pieces which 
siiy broken, and if necessary, reduced to powder. 

M-idical properties- and uses. Lunar caustic is a powerful lyp- 
tic and escharotic, but in limited doses, it may be given safe- 
Iv, and with great advantage internally. It has been recom- 
mended bv Doctor Boudin in low typhoid fever where there is 
good reason to believe the bowels were in a state of ulcera- 
tion. I am told that it is now recommended in our colleges 
for the same purpose, and I have tried it in a few cases with 
satisfactory results. It is also recommended as a general ton- 
ic, and especially in epilepsy and other spasmodic diseases. 
The dose is from a quarter of a grain to two grains, repeated 
several times a day. This dose has been in some cases gradu- 
ally increased to five or six grains. The medicine should al- 
wavs be given in pills. There are several objections to this 
remedv. In the first place, it is subject to be decomposed in- 
stantlv by contact with table salt, which changes it to an inert 
substance. In forming it into pills, crumbs of bread contain- 
ing salt should not be used. In the second place, it some- 
times produces in persons, who continue its internal use for 
some time, a change in the color of the skin : changing it to a 
color almost black. This color is sometimes permanent, and 
at best slowly removed. As an external remedy, lunar caus- 
tic is decidedly one of the most important. It is advised to 
male solutions of it, only with distilled water ; but I think 
common well or spring water is generally pure enough. The 
solution should be strong — from five to thirty grains in an 
ounce of water. A solution of five grains to the ounce, drop- 
ped into the eye. is active for a moment only, the tears fur- 
nishing salt enough to neutralise it at once. Thirty grains to 
the ounce, applied to a ra\v surface, is in a moment neutral- 
ised by the fluid it meets. Yet experience proves this mode 



DISPENSATORY. 709 

of applying the remedy lo be very effective, fn fungous ul- 
cers, or raw surfaces which are without healthy granulations, 
the application of the solid caustic in the stick, is one of our 
best remedies. It should be put in a quill like a pencil and 
applied freely. Jt matters little how tender the surface is, the 
pain will be momentary. It is one of the few remedies, that 
rises in estimation, with experience in its use. 

MAGXESIA. 

This is an earth widely diffused in nature, but obtained for 
medical use only through the powers of chemistry. There are 
two preparations in common use, the carbonate and the cal- 
cined. They are in their places valuable remedies, and com- 
mend themselves by their total freedom from poisonous quali- 
ties. 

Medical pj'operfies end uses. Magnesia is a decided correc- 
tive of acidity. The common kind*, or carbonate, may be ta- 
ken to relieve acidity of the stomach, in doses oi' from one to 
two drachms. It sometimes produces flatulence, when in 
combining with a stronger acid in the stomach, the carbonic 
acid gas is thrown off. But this is a slight inconvenience. 
The calcined magnesia is free from this inconvenience, and 
may be taken in doses somewhat less. In either form, the 
remedy is a mild laxative, and may be used with great safe- 
ty. It may be taken in any convenient vehicle. 

MERCURY. 

Mercury is a metalic substance having the peculiar prop- 
erty of remaining fluid in the common temperature of the at- 
mosphere. It resembles melted lead. In its crude state, it 
is inert, and may be swallowed in safety, to the extent of se- 
veral ounces. Its combinations with other substances are nu- 
merous, and many of these are remedies of great importance. 
Few remedies have been so much used in the treatment of dis- 
eases as this ; and it would be difficult to decide, whether the 
encomiums or the censures thrown on it, have the most force. 
I believe no experienced physician, ever denied its great pow- 
ers as a medicine ; but some attribute to it ultimate effects so 
pernicious, as in a great degree to cancel all its claims as a 
remedy. So strong is the prejudice which has arisen from 
these opinions, that I believe it is generally thought creditable 
to a physician, to say that he uses but a moderate quantity of 



710 DISPENSATORY. 

mercury in his practice. At the South I am not sure, but the 
practice of physicians has justified the prejudice, but nothing 
can take from mercury its pre-eminence as a medicine, tilt 
another and a better is discovered. The ills which sometimes 
arise from its use, have been greatly exaggerated, and the 
ravages of disease, improperly attributed to it in thousands of 
instances. It takes yet longer experience to assign to it, its 
proper place, but the idea of discarding it is wholly absurd. 

Medical 'properties and uses. The preparations of mercury 
which have been used in medicine, are too numerous to men- 
tion. They are all intended to accomplish the same purpose — 
the introduction of the remedy into the system. I have not 
room to discuss the peculiar properties of these preparations, 
but will content myself with observing, that mercury enters in- 
to the system and circulates w T ith the fluids of the body. In 
this state, it is a peculiar stimulant, producing a feverish ex- 
citement of the pulse, and an action on the absorbent and 
glandular system peculiar to itself. Its action on the liver and 
intestinal canal are decided. When continued for a few days, 
it excites and inflames the glands of the mouth and throat, pro- 
ducing considerable swelling and soreness, and a profuse dis- 
charge of saliva. These effects when well understood, give to 
the physician great pow r er over many diseases, which are reme- 
diless without mercury. I think it necessary to mention par- 
ticularly a few of its preparations. 

Calomel, now known to the chemist as the mild chloride of 
mercury, is the most commonly used, and probably the best of 
all the preparations of this metal. It is a mild cathartic, pro- 
ducing a decided action on the liver and mucous surface of the 
bowels, causing discharges of bile and thick mucus, and above 
other cathartics free from producing watery discharges. Used 
in small doses, and repeated from day to day, it causes saliva- 
tion with all the symptoms of a general mercurial excitement. 
The dose of calomel as a cathartic, is from ten to fifteen grains. 
Larger doses do not much increase the obvious action of the 
remedy. To produce salivation, three or four grains a day 
may be given, and if there is reason for wishing a speedy 
effect from it, larger doses w r ith opium combined may be used. 

Blue pill. This preparation is kept in mass by our druggists. 
It is the mildest of the preparations of mercury, and produces 
in a less degree all the effects of calomel. It sometimes re- 
mains on the bowels without acting as a cathartic, where very 
small doses of calomel operate actively. It is considered the 



DISPENSATORY, 



117 



safest remedy for the weak and debilitated. The dose is 
about three times that of calomel. 

Corrosive sublimate. The substance well known by this name 
is the " corrosive chloride of mercury" of the United States 
Dispensatory. It is to be regretted, that its chemical constitu- 
ents and name, so much resemble those of calomel, while its 
medical properties are so widely different. Corrosive subli- 
mate, be it remembered, is in large doses, a violent poison, while 
calomel is one of the mildest of remedies. Corrosive subli- 
mate is never given as an emetic or cathartic, because it is too 
drastic and powerful to be safely used ; but in minute doses, 
it is thought to be one of the best alterative remedies we pos- 
sess. It is thought to be much less liable to produce salivation, 
than other preparations of mercury, while its effect, especially 
on eruptive disorders, is most decided. The dose of corrosive 
sublimate, is from the sixth to the third of a grain. 

Red precipitate. This preparation of mercury is considered 
too harsh for internal use. As an external remedy, it is valua- 
ble in ulcers which are indolent and flabby in their appearance. 
It is applied by sprinkling it equally over the surface. It is 
readily taken into the system from raw surfaces to which it is - 
applied, and I have known it to produce a salivation when ap- 
plied in this way. 

MURIATIC ACID. 

This is one of the stronger acids, and if taken in large quan- 
tity, a corrosive poison. But it is not to be considered un- 
friendly in its nature, for it exists in the stomachs of the most 
healthy persons, and is thought to be essential in the digestion 
of food. It is of great importance in the arts, and as a reme- 
dy, entitled to some confidence. 

Medical properties and uses. The effects of muriatic acid as a 
remedy, are less understood than its frequent use would seem 
to justify. It is a mild tonic, and thought to be cooling in fe- 
vers. In diseases of the skin resembling syphilis, it is an effi- 
cient remedy. I have found it the best remedy for the erup- 
tions frequently found on the children of scorbutic or supposed 
syphilitic parents. The dose to a grown person, is from ten 
to twenty drops, diluted with water, and given two or three 
times a day. A drachm mixed with four ounces of water, 
forms a good gargle or external application for foul ulcers. 

SALT-PETRE. 

It was not easy to choose a name for this common salt. Ni- 



712 DISPENSATORY. 

trate of potassa, is in common language abreviated to nitre, 
and this word nitre conveys to the minds of some, the idea of 
sweet spirit of nitre, and to others weak nitric acid. I have 
chosen salt-petre, which I believe will be always understood 
alike. Salt-petre is a salt compounded of potash and nitric 
acid, and is found native or manufactured by art. It is ex- 
tensivly used in the manufacture of gun powder, and is a valu- 
able remed}% 

Medical properties and uses. Salt-petre is a cooling sedative 
of great value in the treatment of fevers of a high grade. The 
dose is from five to fifteen grains, and may be repeated every 
hour or tw T o. In combination with tartar emetic and calomel, 
it is a remedy of great activity. When continued in consid- 
erable doses, it promotes perspiration, increases the secretion 
of urine, and sometimes operates as a cathartic. In dropsies 
attended with local inflammation, it is a valuable addition to 
other diuretic medicines. In over doses, an ounce for exam- 
ple, taken by mistake for some other salt, it is a dangerous 
poison. I have twice witnessed this accident. It produced 
vomiting and purging, with bloody discharges, sunken pulse, 
profuse perspiration, and universal coldness of the surface of 
' the body. Large draughts of warm tea, with occasional stimu- 
lants and anodynes were successful in relieving these cases. 
No antidote is known for this poison. 

OPIUM. 

Opium is the dried juice of the white poppy, and has been 
used as a medicine from the earliest ages. It is not only a 
valuable medicine ; but used to produce a pleasing excitement, 
by those who are well. In Persia, Turkey, and China, it is so 
extensively used, or rather abused, that the ills arising from it, 
are thought to equal those we see from the abuse of alcohol, in 
our own country. Still no one could wish the drug had not 
been discovered ; for without it, the physician had better aban- 
don his calling. The labor and skill required in the produc- 
tion of opium are considerable. It is a great article of com- 
merce, and although easily raised in any temperate climate, 
bears a high price. That which we use in the United States, 
is mostly obtained from Turkey or Egypt. 

Medical properties and uses. Opium is a powerful stimulant 
and narcotic. These properties have been thought to reside in 
different portions of the drug, and it has been analysed with 
more labor and research, than any other article. The result 



DISPENSATORY. 713 

of these researches, leaves the matter yet unsettled. Every 
preparation of opium is a stimulant as well as a narcotic, and 
the difference between the effect of one and another, can 
scarcely be told from its consequences. For example, solid 
opium, laudanum, and morphine produce the same effect. It 
is true, we meet with persons ; who are affected differently by 
these different preparations; but the difference on investigation, 
will commonly be found to be slight, and more frequently ima- 
ginary. The immediate effect of opium when taken, is to pro- 
duce great exhilaration of mind, and a strong, but rather slow 
pulse. After a time, extremely various in different persons, 
and in the same person, under different circumstances, a mild 
and agreeable drowsiness comes on, and if the dose is suffi- 
cient, a deep sleep. The pulse still continues full, and the 
countenance flushed, and now a perspiration follows, which is 
also a symptom extremely variable. In this state, with more 
or less perspiration, the sleep continues for several hours, when 
the effect of the dose, if it has not been too large, is over. In 
some persons, headache, nausea, &c. follow ; but generally, 
little inconvenience is felt from it, and no permanent injury, 
unless it is too often repeated. It should have been mention- 
ed, that a peculiar excitement of the skin is sometimes one of 
the effects of opium. This is evinced by a burning and itch- 
ing of the face especially about the nose, and sometimes a 
general itching and slight eruption extending to all parts of the 
body. These are the common effects of a moderate dose of 
opium ; but there are many exceptions, growing out of pecu- 
liarities of constitution, and the particular state of the subject 
when the remedy is taken. Peculiarities of constitution sel- 
dom forbid the use of opium, although many persons think it 
always hinders their sleeping. Some it is true are longer un- 
der its exciting influence than others, but at last reap as great 
a reward ; but by far the greater number have taken it improp- 
erly, and thus formed erroneous opinions of their constitutions. 
I have met with but a single individual, who under no circum- 
stances, dared to take opium. To her the drug is uniformly a 
violent emetic, producing great pain, and protracted vomiting. 
But the exceptions to the benefit of opium properly adminis- 
tered, are insignificant. The circumstances under which it is 
proper to give opium, are numerous and important. 

1. In all diseases resulting in sudden or great prostration, 
such as fevers, cholera morbus, and other dangerous diseases, 
opium is a standard remedy. 



714 DISPENSATORY. 

2.. Where there is intense pain from almost any cause, we 
have no remedy equal to this. 

C. I., iiaeasee attended with morbid wakefulness, it is our 
best remedy. 

4. Where intense pain is produced by spasm or violence to 
the nerves of lender organs, opium is our main reliance. 

•5. Were I to attempt to mention the agonising diseases, in 
which opium is our best remedy, I should far exceed my lim- 
its. I might instance tetanus, spasm, colic, chole: . _ ... te- 
nesmus, and gravel, and this is but a be^inni::.. 

6. And finallv, when from our ignorance of the force of our 
remedies, or the strength of our patients, they are prostrated, 
aDd sinking under the violent action of medicine, opium, espe- 
cially laudanum arrests its operation, and in mar. aces, 
saves our patierts fri m death. 

But the; : issc no 3 . _ eent necessary in using, even so great 
a rertt y as opium. It is not a specific for any known i .- 
5 :-.i : . It cures many ; but it is by opposing to them, its known 
and obvious effects. It is a powerful stimulant, and there 
improper in inflammatory diseases. But even in these, it :: 
be beneficially used after the powerful operation of medic: f . 
or after bloodletting. I must not close without mentioning, 
that in a dose too large, opium is a fatal poison, too often 
sought by the desperate to destroy life : but we have in an- 
other place, treated of its poisonous effects. The lose of opi- 
um is one grain, of morphine one third of a grain, and of lauda- 
num twenty :;rops. Tnese doses are small, and may be safe- 
tsed three or four fold, if the sudden exhaustion or vio- 
lent pain demand it. Where the remedy is too often taken, it 
may be generally increased to an extent which would appear 
incredible. 

POTASH. 

Potash is a fixed alkali, derived principally from wood ash- 
es, end too well known to need a descriptor:. I: is alws 
found in combination with other bodies ; the potash whic 

srred for medical purposes, is still combined with car- 
bonic acid. In a state of greater purity, it forms caustic' pot- 
ash. In medicine, it is useful in many of its combinations ; 
but it is our present purpose, to mention only two of its prepa- 
rations. 

Medical properties and uses. Caustic potash is an article of 
vreat activity and power. It is used as an external applica- 
tion to destroy fungous flesh, and even indurated 



DISPENSATORY. 715 

such as corns or warts, are quickly destroyed by it. It re- 
quires skill and judgment in its application, and is objectiona- 
ble on account of its tendency to spread beyond the part to 
which it is applied. The carbonate of potash, or salt of tartar, 
is still an active alkali, bat safe and manageable as a remedy. 
Dissolved in water, it may be taken to neutralise the acidity of 
the stomach, which arises from indigestion. In smaller doses, 
lon^ continued, it is a valuable remedy for red gravel, and 
combined with vinegar, it is a mild diuretic and febrifuge. Its 
diuretic properties are sometimes so great, that it becomes an 
important remedy in dropsy. In hooping cough, where the 
stomach is disordered, I have found it a valuable remedy. 
The dose of the carbonate of potash, is from ten to thirt}* 
grains. Where the potash which has been prepared for medi- 
cal purposes cannot be obtained, there is no danger in using 
the coarse articles which are always at hand. Common pot- 
ash or saheratus will answer. It is also perfectly safe to put 
or three table spoonsful of ashes into a gill of water, stir it 
briskly, and after it has settled, take a table spoonful or more. 
The potash which will be taken up by the water, will be suffi- 
ciently pure, but the strength will vary, and the dose must not 
be too large. The effects of potash as a poison, have been 
treated of under the head of poisons. 

PINK ROOT. 

This is the common name of a plant which is found native 
in our woods, and is a remedy of some importance. It is call- 
ed the Maryland pink, but is much more abundant at the South 
and West, than in that State. The root is the part used as a 
medicine. 

Medical properties one! v.ses. I consider pink root by far the 
best remedy in use, for the destruction of worms. I allude to 
the round worm, which is almost exclusively entitled to our at- 
tention in this country. It may be given in substance or infu- 
sion. The dose of the powdered root is for a child four years 
old, from ten to twentv grains. It is more commonly given in 
infusion. Pour half a pint of boiling water on two drachms of 
pink root, and keep it hot by the fire for half an hour. A child 
four years old, may take half of this infusion at night, and if 
necessary, the balance the next morning. The second portion 
is not to be given, if the first operates as a cathartic, or espe- 
cially if it produces stupor or intoxication. This effect on the 
brain, which sometimes follows the use of pink root, has never 
produced death, within my knowledge. 



716 DISPENSATORY. 

QUIXIA. 

It may not be amiss to state, that this medicine is extracted 
from the Peruvian bark, and is thought to contain all its medi- 
cal virtues. It is in my opinion so far superior to the bark from 
which it is extracted, that there is no necessity for administer- 
ing that remedy in any case. I shall therefore treat only of 
the quinia or rather of the sulphate of quinia, which is its most 
common preparation. 

Medical properties and uses. Till the discovery of the Peruvi- 
an bark, the intermittent fever was pointed at as the disgrace 
of medicine. That remedy was uncertain in its effects, be- 
cause the quinia, its sole medical constituent, was in some spe- 
cimens abundant, and in others very scarce. The physician 
had no certain method of telling the o-ood from the bad. The 
discovery of the method of separating the quinia, from the use- 
less portion of the bark, was highly important, and has doubled 
the value of the remedy. The sulphate of quinia, is the reme- 
dy now universally used. Its most important power is exerted 
over intermittent fever, or chill and fever as it is commonly 
termed. Having treated of its use in this disease, I need not 
repeat it here. But the power of arresting a paroxysm of fe- 
ver, is but a strong example of the general power of quinia, to 
cut short intermitting diseases. Sun pain, or daily paroxysm 
of the headache, is as readity arrested by it as a chill. This, 
and other like examples, of the power of quinia to arrest an ex- 
pected paroxysm of disease, has warranted the attributive of 
antiperiodic, which has of late been given to it. The powers 
by which quinia produces its wonderful effects, have been so 
variously understood, that I feel bound to say, that I do not 
give it as a mere stimulant or tonic. I give it to arrest the 
paroxysms of disease, and if there are no parox} T sms, I have 
very little use for quinia. I do not deny that in small doses, 
it may prove tonic in its effects, but it is not equal to many oth- 
ers. The dose of quinia is undecided. Some give it in doses 
of one, and others of ten grains. It will hardly prove fatal in 
any dose ; but I think the safest plan is to use it in modera- 
tion. Ten grains divided into three or four doses, and given 
within five or six hours of its attack, will arrest a common chill 
and fever. This is a small quantity, and may be increased to 
twenty or even thirty grains, in high grades of fever. I think 
larger doses unnecessary and hurtful. 



DISPENSATORY. 717 

SAGE. 

This perennial plant grows spontaneously in the South of 
Europe. It is cultivated in our gardens, more as a condiment, 
than as a medicine. It is a mild and agreeable aromatic, but 
can hardly be ranked with medicines. A weak infusion of its 
leaves, now generally called sage tea, is a gentle sudorific, and 
may be given with great advantage in connexion with other 
and stronger remedies. It is often chosen by the sick as a sub- 
stitute for tea. 

SQUILL. 

The squill is a bulbous rooted plant of spontaneous growth 
in the South of Europe. It has long been established as a 
remedy of great value. 

Medical properties anal uses. " Squill is expectorant, diuret- 
ic, and in large doses, emetic and purgative." It is a dange- 
rous medicine in ever doses. It is a stimulating expectorant, 
and produces its effect by exciting the lungs ; but it is not on- 
ly useful in promoting expectoration, but also in suppressing 
the copious thin discharges which are sometimes attended by 
disorders of the lungs. It is a component part of Coxes' Hive- 
syrup, and very extensively used in croup, and other diseases 
of the lungs. It is very often used in cases too inflammatory 
for its proper or safe operation. It should be remembered, 
that squill is an acrid, heating remedy. As a diuretic, I think 
it a more valuable remedy. In combination with calomel, it 
is our best remedy for dropsy, and may be beneficially used 
in other diseases where the secretion of urine is deficient. The 
dose as a diuretic or expectorant, is from one to two grains, 
twice or three times a day. In larger doses, it is emetic and 
cathartic. 

SENNA. 

Senna is the leaves of a plant which grows spontaneously 
in Egypt, India, and several other warm countries. There 
are several varieties, and they appear to be mixed together 
without much discrimination. It is an important remedy, and 
it is very desirable that its cultivation should be introduced in 
the Southern States. 

Medical properties and uses. Senna is a prompt and safe ca- 
thartic, and a good deal used in acute and inflammatory disea- 
ses. It is considered a mild cathartic, and it seldom operates 
excessively, but it sometimes produces griping and nausea. 



718 DISPENSATORY. 

These effects are lessened by combining it with the neutral 
salts or with spices. It is generally best to give it in combi- 
nation with other cathartics. With Epsom salts it is the surest 
cathartic I have ever used. The infusion is the most common 
form in which it is given. Pour a pint of boiling water on an 
ounce of senna to make an infusion. Of this infusion, from 
three to four ounces is a dose. I almost always use but half 
the quantity of senna, and add to the infusion one or two oun- 
ces of Epsom salts. From two to four ounces of this, will 
prove cathartic, and seldom produce pain or sickness during 
its operation. 

SPIRIT OF TURPENTINE. 

This is the common name of the oil of turpentine, which is 
known to every one, and therefore need not be described. 

Medical properties and uses. When applied externally, the oil 
of turpentine acts powerfully on the skin, producing redness, 
and if long continued, inflammation. It is a convenient ap- 
plication, and beneficial in local disorders attended with pain 
without much inflammation. It may be rubbed on once a day, 
but should not be repeated many days in succession. As an 
internal remedy, it is valuable in cases of worms. It is fre- 
quently successfully used in destroying the tape worm, and I 
have often seen the round worm and small white worm brought 
away in great numbers by its use. It may be safely taken in 
much larger doses, than its sensible qualities would seem to 
admit of. A child of six years old may take a tea spoonful, 
on half a wine glass full of water with ease and safety. To 
grown persons, it is given in doses of from half an ounce to an 
ounce. These large doses are given for the expulsion of 
worms. They commonly operate as a cathartic, and some- 
times produce stranguary and bloody urine. In smaller do- 
ses, oil of turpentine is given in many diseases. It has been 
beneficial in low protracted fevers, where the intestines were 
thought to be ulcerated. In chronic rheumatism, it is a valua- 
ble remedy. When it is to be continued from day to day, the 
dose should not exceed thirty drops twice a day. If it produ- 
ces irritation of the kidneys, it is to be suspended. 

SUGAR OF LEAD. 

The acetate of lead, or as it is called sugar of lead, is a 
white substance of a disagreeable sweetish, astringent taste. 
It is a combination of lead with vinegar, and so easily decom- 



, 



DISPENSATORY. 71% 

posed, that it is not very much relied on in medicine. It was 
long thought to be extremely poisonous, producing especially 
painter's colic when used even in. small doses. This opinion 
seems now to be exploded, and the remedy is regarded as be- 
ing perfectly safe, even in considerable doses. Other prepa- 
rations of lead are more distrusted, so that at present, I give 
the advice to use no other preparation oflead as medicine. 

Medical properties and uses. As an external application, su- 
gar oflead is a mild astringent. It may be dissolved in water, 
to the extent of four or five grains to the ounce, and used as an 
injection, in gonorrhoea or gleet, or applied to inflamed surfaces 
externally. Water is frequently too impure to be used with 
advantage in making the solution. But where the water in 
which it is .dissolved turns white, and the remedy for internal 
use, it is best to allow it time for precipitation, when it should 
be poured off transparent for use. Internally, this remedy is 
given as an astringent to suppress excessive discharges by the 
bowels. It is also given to arrest hemorrhage, especially from 
the uterus and the lungs. The dose is two or three grains 
hourly, till ten or twelve grains, if necessary, are given. It 
is given in combination with opium. For a long time sugar of 
lead was thought the greatest of remedies in these diseases. 
This opinion seems to be giving way, but the remedy is still 
used. 

SULPHUR. 

Sulphur is an abundant product of the earth, found in mines 
and also as a constituent principle of many vegetable and ani- 
mal substances. It is an elementary substance, and useful as 
a medicine. 

Medical properties and uses. Sulphur is a mild laxative, pas- 
sing slowly through the bowels, and being to some extent, ta- 
ken into the circulation, and passing off by the pores of the 
skin. It is often a valuable remedy in hemorrhoidal affec- 
tions, and is used as an external application in diseases of the 
skin. For curing the itch, it is the most certain remedy we 
possess. It is also given in chronic rheumatism, and some 
disorders of the lungs. 

Sulphuric acid, although derived from sulphur, is so changed 
in its properties, that it would not be suspected of being at all 
the same. This acid, diluted with seven or eight times its 
measure of water, composes the elixir of vitriol of the shops. 
It is improved by combining with it, the essential oils of ginger 
and cinnamon, which give it a strong aromatic flavor, and when 



#20 DISPENSATORY. 

well prepared, should be preferred to the diluted acid, with- 
out these aromatics. These preparations do not differ so 
much in their medical properties, as to require much care in 
the choice between them. Elixir of vitriol is a mild and ex- 
cellent tonic medicine, and may be given with great advan- 
tage in the low forms of chronic fever, and for the removal of 
debility from any cause. It is given for the removal of night 
sweats in consumption, and for many other diseases. The 
dose is from ten to thirty drops in water, two or three times a 
day. It is advised to protect the teeth from its action, by 
drawing it through a quill ; but I think if it is quickly swallow- 
ed, the injury it can do the teeth, is very trivial. 

TARTAR EMETIC. 

As a medicine, antimony is scarcely less important than 
mercury ; but I have room to mention only its most important 
preparation. Tartar emetic, or the tartrite of antimony and 
potash, is composed of antimony in combination with tartaric 
acid and potash. It is a powerful and valuable remedy, and 
should be well known before it is prescribed. It is a dange- 
rous medicine if used in excess. In this country, it is so com- 
mon for inexperienced persons, to have both calomel and tar- 
tar emetic in their possession, that I think it important to say 
a word as to their discrimination. Both are sold in the form 
of white powder, and both have a heavy metalic weight ; but 
calomel taken between the fingers, is exceedingly fine and 
smooth, adhering to whatever it touches : tartar emetic on the 
contrary, is a rough powder, falling from the fingers readily, 
and leaving scarcely any impression. A test so simple, should 
not be neglected. 

Medical properties and uses. In full doses, tartrite of antimo- 
ny is a powerful emetic, producing frequent and thorough dis- 
charges from the stomach, with great force and straining. It 
reduces the pulse, causes a profuse perspiration, and finally 
operates as a cathartic. In smaller doses, it produces nausea 
without vomiting, and at the same time reduces the force and 
fulness of the pulse, and increases almost every secretion. 
Such a remedy might be expected to have a great influence in 
diseases. We accordingly prescribe tartar emetic in the high- 
est grade of inflammatory fevers, especially, pneumonia and 
pleurisy. In croup, it is also our best remedy. It were end- 
less to particularise the cases in which it is a valuable remedy. 
The dose of tartar emetic is two grains every half hour till it 



DISPENSATORY. 721 

operates. To produce nausea, it is given in much smaller do- 
ses, a quarter of a grain or less. To some persons, the action 
of tartar emetic is too strong to be hazarded, and in some in- 
stances, the remedy operates as a powerful emetic and cathar- 
tic, and prostrates the patient in a short time. Laudanum is 
the great remedy in these cases. When applied to the skin, 
it produces a powerful and often valuable operation. 

UVA URSI. 

Uva ursi is a low evergreen shrub of cold climates, whose 
leaves have long maintained their place amongst the standard 
remedies of the profession. 

Medical properties and uses. Uva ursi is astringent and tonic, 
having in its effects a particular operation on the urinary or- 
gans. It is given in diseases of the kidneys, and is thought to 
give tone and strength to the kidneys, and to remove a tenden- 
cy to the formation of gravel. In certain disorders of the 
bladder and in leucorrhcea, it has been thought to operate bene- 
ficially. The dose of the powdered leaves of the uva ursi, is 
from half a drachm to a drachm ; but the most convenient 
method of giving it, is to make a decoction from it by boiling 
an ounce of the leaves in a quart of water for a quarter of an 
hour. A wine glass full of this may be taken twice a day. 

MIXTURES, PILLS, OINTMENTS, &C 

Most of the remedies I have recommended, will be sup- 
plied by druggists in forms ready for use, and all of them can 
be readily prepared at any physician's or apothecary's shop in 
the country. But to persons residing in remote situations, it 
may be inconvenient to procure the necessary assistance in 
making these preparations, and I have thought it best to give 
particular directions for a few of the most important. 

ANTIMONIAL MIXTURE. 

Take of saltpetre, two drachms ; tartar emetic, two grains ; 
water, half a pint ; mix in a vial or tumbler. 

This is a powerful emetic and sedative remedy, and highly 
useful in inflammatory diseases. It may be given in larger 
doses, at short intervals as an emetic, and in smaller doses, at 
longer intervals to produce a milder operation. A table spoon- 
ful every twenty minutes, will prove a prompt emetic to most 
persons. Two tea spoonsful every hour will produce nausea, 
and mav be continued as long as necessary. If on giving this 
46 



722 DISPENSATORY. 

mixture, it is found too active, lessen the quantity; if too weak, 
increase it ; for persons differ very much in the quantity of 
this remedy they can use under different circumstances. So 
powerful is this remedy in controlling the pulse, and reducing 
inflammation, that with its efficient use, pleurisy, croup, and 
inflammations of all the important organs, except the bowels, 
may be successfully treated by it, without the use of the lan- 
cet. A table spoonful of the mixture, contains one-eighth grain 
of tartar emetic, and in giving the remedy, the quantity of this 
article is to be constantly kept in mind. 

ANTIMONIAL POWDERS, OR POWDERS OF TARTAR 
EMETIC AND NITRE. 

Take of saltpetre, two drachms ; tartar emetic, two grains ; 
nib them together in a mortar till fully incorporated, and di- 
vide the whole into twelve powders. Each powder will con- 
tain ten grains of nitre, and one-sixth of a grain of tartar 
emetic. 

One of these powders given in water every half hour, will 
operate as an emetic. They may be given at longer intervals 
to produce nausea, and reduce the pulse in inflammatory fe- 
vers. They are composed of the same medicines directed 
above in the antimonial mixture. In dangerous cases where 
it is important to know exactly what remedies are used, the 
powder is to be preferred, as the dose given is more exactly 
known. 

ANTIMONIAL POWDERS, WITH CALOMEL. 

Take of calomel, twenty grains ; tartar emetic, two grains ; 
saltpetre, two drachms ; rub together, till fully incorporated, 
and divide into twelve powders. 

One of these powders may be given in syrup or honey 
hourly, or once in two or three hours according to circumstan- 
ces. In bilious fever, where the pulse is full and strong, and 
the stomach not disordered, I have found this a powerful 
remedy. In diseases of the lungs, I have also used it, with 
the greatest success. 

It is to be borne in mind, that the antimonial powders, with 
or without calomel, and the antimonial mixture, are remedies 
of great activity. They may be altered in their composition 
by lessening or increasing the calomel or tartar emetic to suit 
particular cases. If for instance, on trying them, they prove 
too active, lessen the dose ; if a cathartic effect is particularly 
desired, increase the calomel : if the lungs are affected, in- 



DISPENSATORY. 723 

crease the tartar emetic, if the stomach will bear it ; and above 
all, give these remedies with watchfulness and care, and do 
not press them after they operate as a cathartic ; but if they 
are too active, arrest them with laudanum. 

POWDERS OF IPECACUANHA AND NITRE. 

Take of saltpetre, two drachms; ipecac, thirty grains ; rub 
together, and divide into twelve powders. 

One of these powders may be given in water hourly, or 
once in two or three hours according to circumstances. 

These powders are mild when compared with the antimonial 
powders above described. They are however a valuable 
cooling sedative, and to be used, where the case is milder or 
the patient too debilitated to bear a stronger remedy. In ca- 
ses of pleurisy or of fever which linger for many days, it be- 
comes necessary to discontinue tartar emetic. Many persons 
are constitutionally unable to bear its harsh operation, and 
young children are often unable to take it safely. In all such 
cases the powder of ipecac and nitre is a valuable remedy. 

POWDER OF JALAP AND CREAM OF TARTAR. 

Take of jalap, two drachms ; cream of tartar, half an ounce ; 
mix well together, and divide into six powders. 

One of these powders given in water every three hours, is 
an active cathartic. They may be given in dropsy, and in 
general when a cathartic, to discharge copious fluid matters is 
required. 

POWDERS OF RHUBARB AND MAONESIA. 

Take of rhubarb, two drachms ; calcined magnesia, one 
drachm ; rub well together, and divide into six powders. 

One of these powders in water may be given every three 
hours, as a mild cathartic ; it is particularly beneficial in cases 
of diarrhoea, and during the process of teething in children. 

CALOMEL AND JALAP. 

Take of calomel, ten grains ; jalap, thirty grains; mix to- 
gether, and give in syrup or honey. 

This is a brisk and powerful cathartic, and has been given 
very extensively in the treatment of bilious fever at the South. 
The calomel is often given separately several hours before the 
jalap; by which means the cathartic properties of both remedies 
act at the same time, and with more power. If the patient is 



724 DISPENSATOTY* 

known to be very easily affected with mercury, it is best to 
combine the calomel and jalap together, by which means the 
calomel will be sooner passed off. 

PILLS OF CALOMEL AND GAMEOGE. 

Take of calomel, thirty grains ; powdered gamboge, eight 
grains ; gum Arabic or crumb of bread, sufficient to make the 
whole into eight pills. 

Two of these pills every three hours, are a powerful cathar- 
tic, well adapted to the treatment of the highest grades of in- 
flammatory fevers except such as affect the lungs and intesti- 
nal canal. In inflammation of the womb, they are the best 
remedy I have ever used. 

STRONG CATHARTIC PILLS OF ALOES AND GAMBOGE. 

Take of aloes one drachm, gamboge one drachm and a 
half, moisten with soap and water, rub well together, and 
divide into thirty-two pills. Two or three of these pills will 
operate as a powerful cathartic. They are a well established 
remedy. 

MILDER PILLS OF ALOES AND GAMBOGE. 

Take of aloes one drachm, gamboge ten grains, moisten 
with soap and water, and divide into sixteen pills. The pills 
may be made weaker by dividing the same mass into 24 pills. 
These pills were, I believe, first made by Doctor Murray, 
formerly of Augusta, Ga. I found them in the hands of my 
preceptor, Doctor Bird. They are the best gentle laxative 
for torpid bowels. 

i 

PILLS OF ALOES, RHUBARB AND IPECAC. 

# 

Take of aloes, rhubarb, and ipecac, each thirty grains, mois- 
ten with water, mix and divide into thirty-two pills. A gentle 
laxative pill, to be taken one by one at intervals of six hours 
or more, till the desired effect is produced. 

PILLS OF IPECAC AND RHUBARB. 

Take of ipecac and rhubarb, each thirty grains, moisten 
with water, mix and divide into 24 pills. A mild laxative 
and to be taken as the last mentioned pill. 

PILLS OF ALOES AND EXTRACT OF GENTIAN. 

Take of extract of genlian half a drachm, aloes one drachm, 
mix and make into 24 pills, with ginger or other dry powder. 



DISPENSATORY. 725 

Those are a very safe laxative in dyspeptic cases. From one 
to three are a dose. 

cook's pills. 

Take of calomel 30 grains, rhubarb 30 grains, aloes 30 
grains, moisten with water, mix and make into 32 pills. The 
calomel is the leading article in these pills. They are a safe 
cathartic, and may be given, three or four at a dose. 

PILLS OF CALOMEL AND SQUILL. 

Take of calomel 20 grains, squill 60 grains, moisten with 
water, mix and divide into 32 pills. A powerful remedy in 
dropsy. Two or three a day may. be given, till salivation 
takes place. 

LAUDANUM. 

Take of hard opium, one ounce and a half; proof spirit, 
cogniac brandy or rum, a pint; cut the opium into small 
pieces, put it into a quart bottle, and add the spirit. Let it 
be well corked, and frequently shaken for three weeks. It 
may then be strained through paper, or carefully poured off, 
leaving the sediment, and allowing none to go over which is 
muddy. This laudanum will be better than that commonly 
sold, and it will remain good for any length of time if kept 
close. It should be transparent' if put in a vial, and never 
used if mudd} r , because its strength may be so much increas- 
ed, as to make it dangerous. I strongly recommend that 
families keep no fluid preparation of opium but laudanum, 
and to make themselves well acquainted with the doses suit- 
ed to every age. This course would hinder many fatal errors. 

SIMPLE OINTMENT. 

Take of yellow wax one pound, lard two pounds ; melt 
them together, and stir occasionally till nearly cold. This 
ointment should be hard enough to spread on cloth without 
sinking into it. If it proves too hard, add more lard, and 
melt it again ; if too soft, add wax in the same way. This 
ointment is the proper dressing for ulcers or raw surfaces. It 
is used in making other plasters and ointments. By softening 
it a little by heat, you may easily incorporate with it, red pre- 
cipitate, powdered galls, iodine, lapis calaminaris, or other 
remedies, which it may be desirable to apply on plasters. As 
a general rule, it is best to apply red precipitate, and other 
powerful remedies to ulcers separately, and cover the whole 
with the simple ointment. 



DEFINITIONS 



Abscess. A collection of pus in a cavity. 

Absorbents, Medicines which neutralize acids in the stomach* 

Acarus. The itch insect. 

Acetates. Salts of vinegar with earthy or metalic bases. 

Acetous acid. Vinegar. 

Acute disease. A severe disease with rapid progress. 

Adipose. Fatty — relating to fat. 

Albumen. A constituent part of the blood; white of egg. 

Alkalies. Potash, soda, ammonia. 

Aloes. A bitter stimulating cathartic gum. 

Alum. A valuable astringent medicine in common use. 

Amaurosis. Blindness, palsy of the nerve of the eye. 

Amenorrhcea. Suppression of the menses. 

Ammonia. One of the alkalies, volatile alkali. 

Anasarca. General dropsy, dropsy of the cellular membrane* 

Anchylosis. An adhesion of the bones destroying motion in the 
joint. 

Aneurism. A tumour formed by the dilatation of an artery. 

Angina Pectoris. A painful disease of the heart. 

Anodyne. A medicine which relieves pain. 

Anthrax. A carbuncle, a gigantic boil. 

Antimony. A metalic substance, the base of tartar emetic. 

Antiphlogistic. Opposed to inflammation." 

Amis. The fundament, the lower opening of the bowels. 

Aphtha. Vesicles in the mouth or intestines. 

Apoplexy. Loss of sensation from pressure on the brain. 

Arsenic. A poisonous metalic substance. 

Arthritic. Gouty, relating to gout. 

Arteries. Blood-vessels arising at the heart, and distributing 
blood to all parts of the body. 

Asafetida. A very fetid gum. 

Ascarides. Small white intestinal worms. 

Ascites. Dropsy of the abdomen. 

Astringents. Medicines which contract organs, suppress dis- 
charges, &c. 

Arrow root. A nutritive substance, a kind of starch. 



DEFINITIONS. 727 

Aura epileptica. A symptom of epileps} r , like vapor or air. 
Auscultation. Investigating diseases by listening. 

B. 

Balsam copaiba. A yellowish balsam. 

Belladonna. Deadly nightshade. 

Bichloride of mercury. Corrosive sublimate. 

Blue vitriol. Blue stone, sulphate of copper. 

Blight's disease. A dangerous disease of the kidneys. 

Bronchitis. Inflammation of the lining membrane of the lungs. 

Bronchocele. -Enlargement of the thyroid gland. 

Buboes. Inflammation of the glands of the groin or arm-pit. 

C. 

Cachexia. A depraved habit, with great paleness. 

Capsule. A box. Ligaments enclosing a joint, &c. 

Capsicum. Red pepper. 

Cantharides. Spanish flies. 

Catamenia. The menses. 

Calculus. Stony deposites, chiefly in the urinary organs. 

Cardialgia. Heart-burn. Pain at the cardia. 

Cartilage. A substance softer than bone, composing joints &c. 

Carbonate of soda. An alkaline salt. A valuable antacid. 

Carbonate of ammonia. A pungent alkaline salt. 

Catarrh. A flow of fluid from the nostrils. A bad cold. 

Castor. A medicine, resembling musk. 

Catalepsy. A fixed and unchangeable spasm. A rare disease. 

Cathartics. Medicines which evacuate the bowels. 

Carbonate of Iron. Carbonic acid united with iron. 

Carbuncle. A large and inveterate boil. 

Caustics. Bodies which disorganise animal substances. 

Catheter. An instrument for drawing off' the urine. 

Ccecum. A portion of the intestines. The blind gut. 

Chloasma. Yellow spots on the skin. 

Chronic disease. A disease of long continuance. 

Chorea. Saint Vitus' dance. 

Chyle. The nutritive matter of food. 

Chyme. Digested food, from which the chyle has not been 

separated. 
Colic. Pain in the colon. Pain in the stomach and bowels. 
Comedone. A small pimple on the face. 
Chloroform. A volatile fluid which produces deep sleep to 

those who inhale it. 
Citric acid. The acid of limes or lemons. 



728 DEFINITIONS. 

Coma. Deep sleep from disease, or from poisons. 

Colon. One of the large intestines. 

Collapse. Sudden prostration in disease. 

Corrosive sublimate. Bichloride of mercury. 

Congestion. Accumulation of blood in any part of the body. 

Croton oil. A drastic cathartic. Three drops is a dose. 

Coryza. Running at the nose. Excitement of the nostrils. 

Confluent. Eruptions which run together. 

Creasote. A caustic fluid, extracted from tar. 

Colchicum. Meadow saffron. 

Cynanche. Inflammation of the throat and air passages. 

Cretinism. A state of idiocy, thought to be hereditary. 

D. 

Diaphragm. The great muscle of respiration, which divides 

the lungs from the abdomen. 
Diabetes. A disease causing the excessive discharge of urine. 
Diabetes melletus. Diabetes with sweet urine. 
Demulcents. Medicines capable of correcting acrid humors. 
Decoction. Preparing medicines by boiling. 
Diathesis. Peculiarity of constitution. 
Diarrhcea. Frequent liquid discharges from the bowels. 
Diuretics. Medicines promoting the flow of urine. 
Diagnostic. Symptoms characteristic of a disease. * 

Douche. A column of water thrown on the body. 
Dracunculus. The Guinea worm. 
Duodenum* Twelve fingers breadth of the intestinal canal 

next to the stomach. 
Drastic. Active, violent. 
Dyspepsia. Indigestion. 
Dyspnoea. Difficulty of breathing. Short breath. 

E. 

Emmenagogues. Medicines which promote the flow of menses. 

Encysted. Enclosed in a sac, or cyst. 

Encephaloid. Brain-like. A cancerous tumor. 

Endemic. A disease confined to a particular neighborhood. 

Enuresis. Incontinence of urine. 

Elixer of vitriol. Diluted sulphuric acid. 

Epigastrium. The superior region of the abdomen — pit of the 

stomach. 
Epidemic. A disease prevailing generally. 
Epidermis. The scarf skin — cuticle. 
Epiglottis. A cartilage closing the upper orifice of the windpipe. 



DEFINITIONS. 729 

Epilepsy. Violent convulsions, the falling sickness. 

Epistaxis. Bleeding at the nose. 

Erysipelas. Inflammation of the skin. St. Anthony's fire. 

Ergot. Spurred rye. 

Escharotics. Caustics, which destroy the living organization. 

Exacerbation. A paroxysm of disease. 

Exfoliation. The separation of dead portions of bone. 

Extravasation. The escape of fluids from their proper vessels. 

Excision. Cutting off. 

Expectorant. That which promotes discharges from the lungs. 

F. 

Fauces. The pharynx, or throat. 

Feces. Dregs. Excrement. 

Febrile. Relating to fever. 

Feculent. Foul. Dreggy. Excrementitious. 

Febrifuge. A remedy to allay fever. 

Flocculent. Soft, velvety. 

Flux. A discharge of fluid. Dysentery. 

Fowler's solution. A preparation of arsenic. 

Fungus. An excrescence. A tumour in the flesh. 

Furruncuhcs. A boil. 

G. 

Gadfly. A fly that deposites its eggs in the backs of cattle. 

Gall-duct. A duct carrying bile from the liver to the intestines. 

Gangrene. Mortification. 

Gamboge. A gum resin. A drastic purgative. 

Gastric. Belonging or relating to the stomach. 

Gastritis. Inflammation of the stomach. 

Gelatine. Animal jelly. 

Gentian. A medicinal plant. 

Gland. Glands are soft roundish bodies, of great variety in 
the human system. Some of them, as the liver and kidneys 
separate fluids from the blood, others as the thyroid gland, 
are of unknown uses. 

Globus-Hystericus. Hysteric suffocation. 

Goitre. Bronchocele. A swelling on the throat. 

Gonorrhoea. A contagious venereal complaint. 

Gout. A disease of the joints, caused by intemperance. 

H. 

Hcematuria. Voiding bloody urine. 
Hartshorn, spirit of. Water of ammonia. 



730 DEFINITIONS. 

Hectic fever. A fever, with great prostration of strength. 

Hellebore. A medicinal plant. 

Hemorrhoids. Piles. 

Herpes. A vesicular disease. An eruption. 

Hernia. A rupture, or a tumour from a displaced viscus. 

Hydatids. Watery tumours, supposed to be living beings. 

Hiera ficra. Powder of aloes and canella. 

Hydriodate of potash. A combination of iodine and potash. 

Hydrophobia. Fear of water. Canine madness. 

Hydragogues. Medicines, causing watery discharges. 

Hypertrophy. The excessive enlargement of an organ. 

Hyper ctsthesis. Excessive sensibility. 

Hypochondriasis. A nervous disease with disordered intellect. 

Hypogastric. Relating to the region of the stomach. 

Hysteria. Hysterics. 

I. 
Icterus. Jaundice. 

Ileus. A species of colic. Strangulation of the intestine. 
Iliac. Relating to, or connected with, the flanks. 
Ilium., lleon. The longest portion of the small intestine. 
Incubation. Hatching. The time which elapses between ex- 
posure to the cause, and the appearance of a disease. 
Inflammatory. Causing inflammation. 
Incubus. Nightmare. 

Intermittent. Having intermissions. Intermittent fever. 
Interstices. Spaces or intervals between organs. 
Intestinal. Belonging or relating to the intestines. 
Inspiration. Breathing. Drawing in the breath. 
Ipecac, Ipecacuanha. A mild emetic. 
Iodine. A valuable medicine of a violet color. 
Iris. A membrane surrounding the pupil of the eye. 

J. 

Jaundice. A disease producing yellowness of the eyes. 
Jalap. A purgative medicine. 

Kino. An astringent gum. 

L. 

Lactation. Giving milk. 

Lancinating. A shooting or piercing pain. 

Lapis calaminaris. Impure carbonate of zinc. 

Larynx. The seat of the voice. The top of the trachea. 

Laxative. Opening to the bowels. A mild purgative. 



DEFINITIONS. 731 

Lenticular. Having the shape of a lentil. 

Ligature. A cord or thread, used to suppress hemorrhage. 

Ligament. A strong membrane uniting bones. 

Lithic acid. Uric acid. Acid producing stone or gravel in 

the kidneys or bladder. 
Leucophlcgmatic. A dropsical habit. 
Lobelia. Lobelia inflata. A narcotic emetic. 
Lumbar. Relating to the loins. 
Lumbricus. The round worm. 
Lumbago. Rheumatism affecting the loins. 
Lunar caustic. Nitrate of silver. 
Lupus. A wolf. A destroying ulcer of the face. 
Luxation. The displacement of a bone. 
Lymphatic. Relating to lymph. 
Lymphatic vessels. Very minute vessels transmitting a watery 

fluid into the blood. 

M. 

Marasmus. Atrophy. Wasting of the flesh. 

Malaria. A cause of disease, emanating from the sick, or 
from decaying matter. 

Menses. The monthly evacuation of women. Flowers. 

Metastasis. A transfer of disease, from one organ to another. 

Monomania. Insanity on one subject. Melancholy. 

Miasm. Malaria. 

Morphia. An alkali obtained from opium. The active prin- 
ciple of opium. 

Mercury. A brilliant fluid metal, much used in medicine. 

Mucus. Animal mucilage. 

Mumps. A contagious inflammation of the parotid glands. 

Muriatic acid. Acid of sea salt. Hydrochloric acid. 

Muscat volitantes. Spots like flies floating in the air, seen by 
those who are going blind. 

Music. A valuable remedy obtained from the musk animal. 

Muriated tincture of iron. A chemical compound of iron, muri- 
atic acid, and alcohol. 

Myrrh. A stimulating gum. 

N. 

Nausea. Sickness, near to vomiting. 
Nephritis. Inflammation of the kidney. 
Nettlerash. Mad itch. Urticaria. 
Nitre. Salt-petre. Nitrate of potash. 
Neutralize. To render a medicine inert. 



732 DEFINITIONS. 

Nervous. Belonging, or relating to the nerves. 

Nitric acid. Nitrogen and oxygen. A powerful acid. 

Nomenclature. Terms peculiar to an art or science. 

Neutral salts. Salts composed of two or more substances, but 

possessing the character of neither. 
Nitrate of silver. Lunar caustic. 
Nosology. The art of classifying diseases. 
Nut gall. An excrescence of the oak. Galls. 
Nux vomica. The seeds of a tree of India. A poisonous drug. 

O. 

Oesophagus. Passage from the throat to the stomach. 

Oedematous. Dropsical. Anasarcous. 

Oak galls. Nut galls. Galls. 

Oil of amber. A bituminous oil. 

Opium. A valuable medicine obtained from the white poppy. 

Ovarian dropsy. Dropsy of the ovaries. 

Oxalic acid. Acid of sorrel. A poisonous acid. 

P. 

Pancreas. A glandular body, situated near the stomach. 
Pancreatic. Relating to the pancreas. 

Parasites. Plants or animals, living on other plants or ani- 
mals. Intestinal worms are parasitic animals. 
Papula. A small inflamed tumor of the skin. 
Paralysis. Palsy. Loss of motion in a part. 
Parturition. Giving birth to. Delivery. Labour. 
Parotid. The largest salivary gland, situated below the ear. 
Paroxysm. The most violent period of a disease. 
Pathologogy. A treatise on the nature of diseases. 
Pelvis. The bony structure of the lower part of the body. 
Perinceum. Between the genitals and the anus. 
Pericardium. A loose membrane enclosing the heart. 
Peritonaeum. The membrane lining the abdomen. 
Peritonitis. Inflammation of the peritonaeum. 
Peristaltic. Vermicular. Worm like. 
Pellicle. A thin skin. A floating membrane. 
Percussion. The effect or sound of bodies striking together. 
Pharynx. The throat. 
Petechia. Spots resembling flea bites. 
Phosphate. A body containing phosphorus. 
Phrenitis. Inflammation of the brain. 
Post-mortem. After death. 



DEFINITIONS. 733 

Potash. A fixed alkali. The vegetable alkali. 

Pneumonic. Relating to the lungs. Diseases of the lungs. 

Pneumonia. Inflammation of the lungs. 

Potassium. A peculiar metal. Pure potash. 

Plethora. Over fullness. 

Prognosis. Foretelling the event of a disease. 

Precipitate. To throw down. Medicines obtained by being 

deposited or thrown down, to the bottom of a vessel. 
Phthisic. Asthma. Consumption. 
Phthisis pulmonalis. Consumption of the lungs. 
Protean. Assuming many appearances. 
Prussic acid. Hydrocyanic acid. A deadly poison. 
Prurigo. Intolerable itching. Itching diseases. 
Ptyalism. Salivation. 
Purpura. Purples. A disease. 
Pustules. Small tumours containing pus. 
Pyrosis. Waterbrash. A disease of the stomach. 

Q. 

Quotidian. A fever with a daily paroxysm. 

Quartan. A fever which returns on the fourth day. 

Quinia. An alkaline substance obtained from Peruvian bark. 

R. 

Rectum. One of the intestines. The straight gut. 

Remittent. A fever having remissions. 

Retina. The organ of vision. The expanded nerve of the eye. 

Rhubarb. A cathartic medicine. 

Rheumatism. A painful disease of the joints. 

S. 

Sacrum. The lowest portion of the spine. 

Sanguiferous. Relating to the blood. 

Salivary glands. Glands near the mouth, producing saliva. 

Salivation. A profuse flow of saliva. 

Salaeratus. Impure carbonate of potash. 

Sanious. Thin, serous, watery, bloody. 

Sciballa. Feculent matter in the shape of balls. 

Scirrhus. Hardened flesh. Cancer. 

Seton. An issue made by a skein of thread passed through 

the skin. 
Scorbutus. Scurvy. 
Scrotum. The skin which covers the testicles. 



734 DEFINITIONS, 

i 

Scrofula. A disease of the glands, skin, or lungs. King's evil. 

Sebaceous glands. Glands of the skin, secreting a fatty substance. 

Serous. Producing serum. Relating to serum. 

Serum. The watery portion of the blood. 

Sinapism. A cataplasm of mustard. 

Sloughing. Dead flesh falling: out of a foul sore. 

O t CD t O 

Spigelia marylandica.. Pink root. 

Sedative. Medicine which decreases action. 

Sphincter. Muscles which close natural openings. 

Spiritus etheris nitrici. Sweet spirit of nitre. 

Spirits of mindereras. Solution of acetate of ammonia. 

Spirit of ammonia. Aromatic spirit of ammonia. 

Spleen. A spongy body seated near the stomach. Its uses 

are unknown. 
Somnambulism. Sleep walking. 
Squill. A valuable medicine. 
Soda. A fixed, alkali. The base of sea salt. 
Stertorous. Deep snoring. 
Stramonium. Jameston weed. Thorn apple. 
Strabismus. Cross eyes. 

Stethoscope. An instrument for investigating diseases. 
Sordes. A foul discharge from ulcers. 
Spasm. Convulsions. 

Sudamina. A light eruption caused by excessive perspiration.. 
Sternum. The breast bone. 
Sudorifics. Medicines producing sweat. 
Styptic. Astringent. 

Sti-ychnia. The alkaline principle of nux vomica. 
Sulphate of copper. Blue stone. 
Sulphate of zinc. White vitriol. 
Sulphate of quinia. The salt of quinia. 
Suppuration. The forming of matter or pus. 
Sulphuric ether. Ether formed from sulphuric acid and alchohol 
Sulphate of iron. Copperas. 
Synochus. Inflammatory. Inflammatory fever. 
Synocha. A fever somewhat inflammatory. 
Sweet spirit of nitre. Nitric ether. 
Syphilis. The venereal disease. The pox. 
Syphilitic. Relating to syphilis. Arising from syphilis. 

T. 

Tannin. A substance in oak bark. An astringent principle. 
Tapioca. A nutritious substance from the cassava root. 
Tartarized antimony. Tartar emetic. 



DEFINITIONS. 735 

Thyroid gland. A gland on the neck. Its uses unknown. 

Tcniia. The tape worm. 

Teguments. Integuments. The skin. A covering. 

Tenesmus. Painful, but vain efforts to pass feces. 

Tea. The tea plant or its infusion. An infusion. 

Tetanus. Locked-jaw. 

Trachea. The wind-pipe. 

Tic douloureux. Nervous pain of the face. 

Tissues. Parts composing the various organs of the body. 

Tincture. Medicines dissolved in spirit. 

Trembles. Milk sickness. 

Trismus. Locked-jaw. Tetanus. 

Tonics. Medicines which give strength. 

Tertian. A fever with paroxysms on the third day. 

Trochar. An instrument for tapping in dropsy. 

Tubercle. A tumour in an organ, or in the flesh. 

Tumefaction. Enlargement, swelling. 

Typhoid. Resembling typhus. Relating to typhus. 

Typhus. A fever with prostration. The same with typhoid. 

Typhomania. Delirium in typhus. 

U. 

Ulcer, A running sore. A solution of continuity in the flesh 

or skin, not caused by a wound. 
Ureter. A tube for the transmission of urine from the kidney 

to the bladder. 
Urethra. The canal through which the urine is discharged. 
Urticaria. Nettlerash. Mad itch. 

V. 

Vagina. A sheath. The passage to the womb, in females. 
Vascular. Relating to vessels. Filled with blood vessels. 
Valerian. A medicinal plant. 
Varix. A dilated vein. 

Varicose reins. Dilated, ulcerated, or bursted veins. 
Vermiform. Resembling a worm. 
Variola. The small-pox. 
Varioloid. Resembling small-pox. 
Venereal, Syphilis. Pox. 
Verdigris. Acetate of copper. 

Ventricle. A small cavity. A chamber of the heart, &c. 
Vertigo. Giddiness. A sensation, as if surrounding objects 
were in motion. 



736 WEIGHTS AND MEASURES. 

Vesicle. A bladder. A blister on the skin. 
Virus. Poison. The matter transmitting disease. 
Visceral. Relating to the viscera. 
Vomica. A collection of pus in the lungs. 

W. 

Water brash. Vomiting a watery fluid. 

Z. 

Zona ignea. Herpes zoster. Shingles. 



WEIGHTS AND MEASURES. 

The following are the weights and measures used by the 
apothecaries of the United States, and constantly referred to 
in this book. 

weights. 

20 grains are one scruple 9. equal to 20 grains. 
3 scruples are one drachm 3- " " 60 grains. 
8 drachms are one ounce 3. " " 4S0 grains. 

The reader should be particular in understanding these 
weights and the marks on them. He should never forget the 
grains contained in a scruple, or a drachm. 

MEASURES OF FLUIDS. 

60 drops or minimus one drachm 3. 

8 drachms are one ounce 3. 
16 ounces one pound or pint. 

8 pints one gallon. 

These measures relate to water, but vary in their applica- 
tion to heavier or lighter fluids. 
'For common purposes. 
* A teacup full is four fluid ounces, or a gill. 

A wineglass full is two fluid ounces. 

A table spoonful is half an ounce. 

A tea spoonful is a fluid drachm. 

The tea cups and spoons now in use, are a little larger than 
the measures they are made to represent. The reader will 
take notice of this, and regulate his use of them accordingly. 



DOSES OF MEDICINES. 



Every person who gives medicine, ought to have some 
knowledge of the quantity proper for a dose, and of the 
proportion of that dose which it will be proper to give to per- 
sons of various ages and temperaments. The doses recom- 
mended in this work are, when it is not otherwise expressed, 
intended for persons of mature age and good constitution. 
But there are many persons, who from excessive sensibility or 
other obscure causes, are unable to take safely a full dose of 
active medicine. To such persons, the dose should be ac- 
cordingly lessened. Old persons also, as a general rule, re- 
quire smaller doses than those of youth or middle age. As a 
general rule, the following table of Gaubius is referred to as 
good authority. 

If the dose of a person of middle 

age is 1 or 1 drachm, 60 grs. 

That of a person 14 to 20 years will be § or 2 scruples 40 grs. 



7 to 14 


tt 


i or i 


drachm 


30 grs. 


4 to 7 


tt 


« i or 1 


scruple 


20 grs. 


4 


a 


£ or 1 


u 


15 grs. 


" 3 


a 


" 1-6 or 1 


(1 


10 grs. 


2 


t% 


i or 1 


tt 


Sgrs. 


1 


it 


" 1-12 or 1 


tt 


5 grs. 



There are some medicines which have in their operation 
something peculiar, and admit of being given to children in 
larger doses than the above, in proportion to their* ages. Cas- 
tor oil and calomel are examples. But as the subject is par- 
ticularly important to persons who are but little acquainted ( 
with medicine, I subjoin the principal articles advised by me 
as remedies with their proper doses for persons of different 
ages ; desiring it to be borne in mind, that the doses mention- 
ed are considered moderate, and may be lessened or increased 
as the patient may appear to have less or more vigor than is 
common to others, and that females in general, require smaller 
doses than men. 
47 



738 



A TABLE OF MEDICINES. 



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